We are seeking a talented Certified Coding Analyst with prior experience in ensuring all claims billed are appropriately coded per coding standards and adheres to all rules and regulations. This position educates providers on their billing practices, internal staff on coding standards and assists in the claim review process. 

 
Responsibilities: 

• Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review 
• Reviews and analyzes professional, facility/institutional and pharmacy claims and supporting documentation for Common Procedural Terminology (CPT), HCPCS Level II, Health Insurance Prospective Payment Systems (HIPPS), and International Classification of Diseases (ICD) code verification to include accuracy and completeness. 
• Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding & billing 
• Makes coding determinations based on coding standards of practice and all applicable rules and regulations.  
• Applies coding knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care. 
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to coding, and billing, with demonstrated ability to interpret such guidelines 
• Take calls from providers to answer any coding related questions they may have. 
• Demonstrates commitment to continuous learning keeping current with evolving quality payment programs, risk-adjusted data requirements and emerging trends in provider reimbursement landscape. 
• Provides clinical support and expertise to the other investigative and analytical areas 

Minimum Qualifications: 

• Experience in a cost containment, payment integrity or fraud, waste and abuse department
• Associate degree in healthcare-related field OR equivalent work experience 
• Analytical skills related to coding across multiple providers
• 3 years' experience in healthcare billing 
• CPC, COC, CIC, or other AAPC designated credential 
• Demonstrated knowledge of CPT, HCPCS, and ICD-10 rules and regulations 
• Experience with provider communication and education
• Excellent written and verbal communication skills

Preferred Qualifications: 

• Bachelor's degree in healthcare-related field OR equivalent work experience 
• 5 years' experience in a professional, institutional and pharmacy billing
•  Coding experience in multiple specialties 
• Experience in multiple software platforms and/or ability to query large data sets
• Multiple coding certifications (CPC, CIC, COC etc.) 

FraudScope is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.