Outpatient Medical Billing and Coding Analyst and Cost Reviewer [PR0001C]

ProSidian Seeks a Outpatient Medical Billing and Coding Analyst and Cost Reviewer (Full-Time) in CONUS - Fort Stewart, GA to support an engagement for a branch of the United States Armed Forces' Regional Health Command who's mission is to provide a proactive and patient-centered system of health with the focus on athe medical readiness of all Soldiers and for those entrusted to the care for a medically-ready force.  The Armed Forces' overall mission is "to fight and win our Nation's wars, by providing prompt, sustained, land dominance, across the full range of military operations and the spectrum of conflict, in support of combatant commanders".  The Regional Health Command's Readiness Mission includes dental care of active duty Soldiers, public health services, veterinary services, and providing management and support to wounded, ill and injured Soldiers assigned to its seven warrior transition units. 

The ProSidian Engagement Team Members work to provide health coding services to a branch of the United States Armed Forces' Regional Health Command- Atlantic (RHC-A) military treatment facilities and provide services to MTFs located in the National Capital Region and the following RHC-A Medical Treatment Facility (MTFs) locations: AL | PR | FL | GA | KY | DC | MD | PA | VA | NY | NC | SC.  Additionally, the vendor may be required to provide coding services to other military services (i.e. U.S. Navy, U.S. Air Force).  The ProSidian Contract Service Providers (CSP) will work in conjunction with other health care providers, professionals, and non-contract personnel.

MD - Medical Billing & Coding Candidates shall work to support requirements as a Outpatient Medical Billing and Coding Analyst and Cost Reviewer and review outpatient health records and/or Electronic Medical Record (EMR) for appropriate evaluation and management services. This position will validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records. Will employ critical analysis and coding skills to review outpatient records for quality and comprehensive coding.

• Prepares and maintains a variety of statistical reports and records while ensuring strict confidentiality of financial and medical records.
• Responsible for resolving questions, inconsistencies, or missing information
• Conducts high level of bill review
• Resolves daily coding scrubber errors to insure accurate coding structure for correct billing.
• Resolves claim denials related to coding errors; performs coding charge corrections and rebilling as required for the resolution of coding denials.
• Advises and instructs providers regarding billing and documentation policies, procedures, and regulations.
• Interacts with provider staff regarding conflicting, ambiguous or non-specific medical documentation, obtaining clarification of same; and educates providers regarding changes and measuring compliance.
• Develops preventive measures in response to patterns identified through analysis of claims denial data and HCC reviews; prepares periodic reports for the HCC findings, trends and clinical staff identifying corrective measures necessary to resolve denial problems.
• Compiles and reports HCC statistical data