01Responsibilities
Extracts information from resources and translates information needed to form appropriate logic for rules.Identify necessary and potential changes to existing medical rules through the review of current and historically available medical policies, transmittals and bulletins.Completes reviews of medical policies and publications and its integration into the required database on a timely basis. Identifies patterns of improper coding or errors in policies and publications and is able to resolve and recommend alternate codes, or code representation in appropriate table(s) (ICD-10, CPT/HCPCS, CCI_Edits)Review of National Coverage Determinations for PPH National policies, assigning appropriate diagnosis and procedural codes for incorporation into Medicare Medical Edits.Builds and maintain data and medical rules tables for multiple Experian Health products in Microsoft Access.Independently reviews, prepares and make appropriate adjustments to data editorial for release to production.Independently completes production data release process.Complete in-depth, independent review of support cases, responding to and discussing with clients as necessary.Responsible for timely and accurate research of resources that update critical information on a scheduled basis. Stay informed about current coding issues. QualificationsExperience with and knowledge of Current Procedural Terminology (CPT) Coding, and International Classification of Disease (ICD-10) Codes requiredAbility to understand and retain coding information and transfer that information into completed product data.Knowledge of Medical TerminologyKnowledge of anatomy and physiologyKnowledge of Medicare reimbursement guidelinesResearch, analyze and draw conclusions regarding medical editsPrior experience in developing medical policy editsPrevious Healthcare experiencePrior experience in developing medical policy edits desiredPrevious experience as an outpatient Medical Coder is a plus Educational requirements:Associate's or Bachelor's degree in the Life Sciences or Accredited Record Technician's certification (ART) or Certified Procedural Coder certificate (CPC) or a combination of training, education and experience that is equivalent to the standards listed and that provides the required knowledge and abilities Additional InformationThis is a permanent home-based role in Costa Rica. No Visa sponsorship or relocation available.**Our benefits include: Medical, life and dental insurance, Asociacin Solidarista, International Share Save Plan, Flex Work/Work from home, Paid time off, Annual Performance Bonus, Education Reimbursement, Family Bonding, Bereavement Leave, Referral Program, and more.Experian is proud to be an Equal Opportunity and Affirmative Action employer. Our goal is to create a successful, inclusive and diverse team where people love their work and love working together. We believe that diversity, equity and inclusion is important to our purpose of creating a better tomorrow. We value the uniqueness and want you to bring your whole, authentic self to work. For us, this is The Power of YOU and it ensures that we live what we believe.Experian Careers - Creating a better tomorrow togetherFind out what its like to work for Experian by clicking here#LI-REMOTE #LI-SA1This is a remote position.
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Company : Experian
Salary : Work from home .
