Remote Pre Litigation Case Manager Jobs in Victoria, TX

Description
JOB SUMMARY
Provide the outpatient coding skills necessary for the coding of all diagnoses and procedures after a thorough review of medical record for optimal reimbursement.
Job Specific:

1. Responsible for coding and abstracting outpatient accounts, not to exceed a bill hold status of three (3) days post the date of service/discharge.(EF)
2. Maintains productivity standards for assigned work type with a minimum of 95% accuracy(EF)
   1. Observation = 5/hours
   2. Emergency Department = 15/hour
   3. Outpatient Testing = 30/hour
   4. Ambulatory Surgery = 5/hour
   5. Inpatient = 2/hour
3. Assigns ICD-10-CM/PCS and CPT codes with accuracy, ensuring that all assigned codes have adequate physician documentation.(EF)
4. Understands computer systems and possesses the ability to reconcile various accounts, charges, including correcting discharge dates, and requesting billing to link accounts, as necessary.(EF)
5. Works independently in coding as a remote employee. Troubleshoots and assists analysis of system issues independently with IT assistance.
6. At the start of each day, review your virtual and coding worklists in Optum to prioritize work.
7. Reviews medical record for medical diagnosis/procedures ensuring assignment of all diagnosis treated and procedures performed.(EF)
8. Analyzes charges for edits and pends account for charge review and/or modifier correction to ensure an accurate claim at the time of billing.
9. Utilizes Optum computer-assisted coding and encoder to assign ICD-10-CM/PCS codes, CPT codes, and modifiers and validates the E&M level based on the medical record documentation.(EF)
10. Approves the code assignment by sending account to billing.(EF)
11. Completes physician and/or provider query for documentation clarification/missing documentation when appropriate.

Hospital:

1. Adheres to organization-wide and other applicable policies and procedures.
2. Day-to-day performance complies with the hospital's Service Excellence Behavioral Expectations.
3. Performs within the prescribed limits of the hospital's Ethics, Compliance and Confidentiality Program guidelines.
4. Performs within professional Scope of Practice at all times.

Other Duties As Assigned:

• Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

Minimum Requirements
EDUCATIONAL REQUIREMENTS
Required: Successful completion of an approved coding program
Preferred: Associate's degree in health-related field OR possess preferred licensure/certification listed below along with high school diploma.
EXPERIENCE
Preferred: Six (6) months coding experience in an inpatient or outpatient setting.
Special Skills and Abilities
Required: Entry level ICD-10-CM/PCS and CPT coding knowledge.
Preferred: Advanced Outpatient ICD-10-CM/PCS and CPT coding knowledge and scoring a minimum of 80% on pre-employment coding test.
LICENSURE / CERTIFICATION REQUIREMENTS
Required: Certificate of completion of approved coding program
Preferred: AHIMA Certified Coding Associate (CCA) or AAPC Certified Professional Coder (CPC)
COMPANY PROFILE
Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted "Best of the Best" hospital in Victoria for 13 consecutive years, Citizens Medical Center is a level III Trauma Center, with a newly renovated 24/7 Emergency Department that includes an onsite medical helicopter. Citizens has a comprehensive Community Cancer Program that includes two linear accelerators and HDR brachytherapy. Citizens is recognized for its outstanding cardiology program which includes a nationally accredited Chest Pain Center and is a Primary Stroke Center. Citizens also includes a comprehensive, accredited Bariatric Surgery program, Birth Center with labor and delivery, an imaging and surgery center, sleep study center, state-of-the-art rehabilitation and fitness center, urology center and daVinci robotics minimally invasive surgery options, a home health agency, and has a long history of providing continuing education for healthcare providers and the community.
Citizens Medical Center is looking for employees who actively demonstrate service excellence by exemplifying our iCare values. If you are someone who displays respect and enthusiasm for patients, visitors, and coworkers while consistently upholding the hospital's commitment to providing outstanding outcomes, service excellence, and fiscal responsibility, then you could be a good fit for the CMC team!
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