MAXIMUS is a leading operator of government health and human services programs and has partnered with state, federal and local governments to provide critical, high quality health and human service programs to a diverse array of communities. Operating under MAXIMUS’s founding mission of Helping Government Serve the People® since 1975, MAXIMUS Federal Services is entirely focused on helping government agencies run programs cost-effectively and serve program constituents with improved outcomes. By being a responsible steward for government programs, we help the federal government deliver on its promises through our people, process and technology. Our focus is always on outcomes and results that connect citizens more effectively with government services.
This project will be supporting the National Medicare and Medicaid Correct Coding Initiative (NCCI), a Center for Medicare and Medicaid Services (CMS) initiative to prevent improper payments and promote consistent coding for national programs. The NCCI program functions to promote program integrity and compliance through guidance, edits, and other methodologies that promote the consistent administration of CMS payment policies in instances where the manipulation of coding could lead to inappropriate, increased reimbursements.
Working remote is an option and would depend on experience, expertise and proven ability to meet workload standards.
• Abstract and code clinical data
• Audit medical records to ensure compliance with the organization's coding procedures and standards
• Utilize specialized classification software to assign or validate procedure and diagnosis codes according to established policies and procedures
• Reviews and abstracts the demographic, financial and clinical data from the medical record for the purpose of assigning ICD-9/10 diagnosis/procedures, HCPCS, CPT, modifiers and units
• Verifies proper CPT and diagnosis coding is entered in the appropriate system based on the level of service provided and documented in the electronic health record by provider
• Determine appropriate claims pricing/reimbursement methodology
• Collaborate with the client to address policy issues that arise in the content of review Ensure process is being completed timely according to contract regulations
• Abstract and sequence codes into encoder software and correct information that has been rejected, as well as correct any identified data errors or inconsistencies
Education and Requirements:
• High School Diploma or GED is required. An Associate’s degree from an accredited college or university is preferred.
• At least five (5) years of Medical Coding experience required
• Must have a current certification of RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), CCS (Certified Coding Specialist) or CPC (Certified Professional Coder)
• Experience in interpreting HCPCS / CPT codes and coding conventions
• Experience in performing and interpreting computer analysis of Medicare Part B claims
• Experience in working with Medicare Part B and Medicaid claims processing systems
• Experience in interpreting/coding ICD-9-CM and ICD-10-CM codes and narrative, and linking ICD-9-CM and ICD-10-CM codes to procedure codes for medical necessity
• Experience working with Medicare and Medicaid payment policies
• Must be able to successfully clear the agency background check - National Agency Check and Inquiries (NACI) with fingerprinting
• Must be a US Citizen