“We are Hiring!”
How exciting is this? To be able to work along with a dynamic team, its
development, logic, and compliance elements. All geared to lower the cost of
Healthcare for our clients.
ClaimReturn is a fun place to work!
Medical Recovery Specialist: CHC Certified
ClaimReturn, Inc is seeking to add to its Revenue Recovery Team. We are seeking
Medical Accounts Receivable Recovery Specialists. This position is remote “work from your home.”
These modified and flex full time positions are available for the ideal candidate. This position is
base hourly wage “PLUS” commission.
ClaimReturn provides the equipment, technology, training and ability for your success.
Under direct supervision of the Recovery Manager, this part time position manages outstanding
AR and performs collections management and retrieval, adjusting, and processing tasks in accordance with
office policy and procedure. Candidate must be highly organized, patient, and proactive. Must be able to work
well independently and with others in our inviting and energetic workplace.
- 2-years experience in medical billing/medical collections
- Excellent Phone Etiquette and verbal communication
- Experience with claims follow-up and electronic filing
- Strong communications, negotiations and “people” skills are required
- Experience navigating any EMR and/or billing software
- Working knowledge of collection routines
- Ability to read and interpret payer contracts and explanation of benefits
CPC: Certified Professional Coder
A certified professional coder (CPC) is responsible for
overseeing the medical coding for healthcare agencies. Coders make sure that medical coding used
is in compliance with all medical coding laws and regulations and ensure that the coding used is
for reimbursable expenses when necessary.
- Protect the security of medical records to ensure that confidentiality is maintained.
- Determine pricing integrity exists.
- Compile, abstract and affect patient medical records
- Document that proper condition and treatment was rendered.
- Review records for completeness, accuracy and compliance with regulations.
- Comply with all legal requirements regarding coding procedures and practices.
- Conduct audits and coding reviews to ensure all documentation is accurate.
- Review assigned and sequenced codes for services rendered.
- Collaborate with billing department to ensure all bills are satisfied in a timely manner.
- Communicate with insurance companies about coding errors and disputes.
- Submit statistical data for analysis and research by other departments.
- Contact physicians and other health care professionals with questions about treatments or diagnostic tests given to patients regarding coding procedures.
- A thorough understanding of third party and governmental payers and billing.
- Experience with medical coding edits from third party payers and CMS coding.
Medical Claims Compliance Auditor, Billing & Coding
Conducts extensive auditing and monitoring of medical record documentation to ensure the documentation adequately supports services coded and billed in accordance with the appropriate state and federal regulations and/or standards.
- Validates ICD-10-CM and ICD-10-CM-PCS codes appropriateness to ensure consistency and efficiency in in and outpatient claim processing, data collection and quality reporting
- Conducts audits on other compliance-related topics as determined to evaluate compliance with the state and federal laws, regulations, and policy
- Communicate to key stakeholders regarding audit findings and corrective actions, if necessary.
- Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations.
- Advise revenue cycle and senior leadership on regulatory requirements for coding documentation and billing to ensure services are submitted according to payor guidelines.
- Works on joint projects with OECAS staff to resolve coding, billing, and documentation issues and act as the expert on billing and coding related topics.
- Maintains a current understanding of regulatory trends and changes in coding policy and reimbursement methods.
- Responsible for reviewing analyzing and understanding medical claims data as a claims and audit expert to help us to monitor, improve and test our claims.
- Bachelor’s Degree in Business Administration, HIM, Health Administration, Nursing is required.
- 5 or more years of experience in healthcare auditing and medical coding and billing.
- Extensive knowledge of CMS, Medicaid, third-party payer coding, billing, and compliance regulations required (APC, APG, ICD10-CM, HCPCS, CPT, Modifiers, Revenue Codes, etc.).
- In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, and post-payment system.
- Experience in an academic medical center setting is strongly preferred.
- Extensive knowledge of key revenue cycle processes, clinical documentation, and financial operations is strongly preferred.
- Data Analytics experience is strongly preferred.
- Expert proficiency with associated technology solutions such as Microsoft Excel, Word, and Access is strongly preferred.
- Ability to identify, interpret, and summarize relevant policy and regulation in a clear and timely manner is essential.
- Experience researching and interpreting regulation and performing internal investigations is essential.
- Must be able to demonstrate a high degree of professionalism, enthusiasm, and initiative daily.
- Ability to work in a fast-paced environment is a must.
- Must have the ability to manage multiple tasks and projects, forge strong interpersonal relationships within the department, with other departments, and with external audiences.
- Attention to detail is critical to the success of this position as is the ability to deal with ambiguity.
- Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities.
Licensure, Certifications, and Clearances:
CCS, CIC, or CMC Required Certified Coding Specialist (CCS)Certified Inpatient Coder (CIC)Certified Medical Coder (CMC), COC, or related are a plus.
- Certified Coding Specialist (CCS)
- Act 33 with renewal
- Act 34 with renewal
- Act 73 FBI Clearance and or its equivalent
Contract-Estimated 3 month. Additional Contract potential. Virtual.
Medical Claims Compliance Auditor, Billing & Coding
NOTE: Positions are virtual while working out of a secured home office. ClaimReturn, Inc. is AICPA SOC2 Certified,
HIPAA compliant and AZURE Secured.
ClaimReturn, Inc. strictly adheres to EEO Affirmative
Action compliance comply with federal, state and local authorities. This affords
ClaimReturn the ability to provide equal employment opportunity (EEO) to all persons regardless
of age, color, national origin, citizenship status, physical or mental disability, race, religion,
creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital
status, status with regard to public assistance, veteran status, or any other characteristic protected by
federal, state or local law. In addition, ClaimReturn will provide reasonable accommodations for qualified
individuals with disabilities.
It is our culture to provide “an approved to fail workplace.” We believe that the spirit of success
is achieved through the fostering of a positive and attentive work environment driven by accountability
- We are a Client First Company.
- We value every individual whether it is an employee, or his/her family.
- We encourage a supportive team environment.
- We appreciate and celebrate diversity in the workplace.
- We believe in evaluating by quality first, not quantity.
During your discussions with our leadership, ask Why not? Why are you not working along with our world-class team?
Kevin Tomkiel, President