Job Description
Job Description: Medical Biller/Coder with HEDIS, MRA, and Utilization Management Experience
Location: Altamonte Springs, FL
Job Type: Temp to Perm
Monday -Friday 8am-5pm
Reports To: [Department Manager/Supervisor]
Work Environment: office setting, remote, hybrid
Pay Rate: $20.00
Minimum of 3 years’ experience.
Job Summary:
We are seeking an experienced and detail-oriented Medical Biller/Coder to join our team. The ideal candidate will have specialized knowledge in medical billing and coding, with a strong background in HEDIS (Healthcare Effectiveness Data and Information Set), MRA (Medical Record Audits), and Utilization Management. This role requires the ability to ensure accurate coding, billing, and compliance with healthcare regulations while optimizing reimbursement and ensuring proper utilization of medical services.
Key Responsibilities:
1. Medical Billing & Coding:
o Accurately code diagnoses, procedures, and services using ICD-10, CPT, and HCPCS codes for insurance billing.
o Review medical records, patient charts, and provider documentation to ensure accurate coding.
o Submit clean claims to insurance companies and follow up on unpaid claims, denials, and rejections.
o Resolve discrepancies between provider documentation and billing data.
2. HEDIS Reporting:
o Assist in the collection, coding, and reporting of data for HEDIS measures to ensure compliance with performance and quality benchmarks.
o Work closely with healthcare providers and other stakeholders to gather necessary clinical documentation for HEDIS reporting.
o Support data abstraction and ensure that accurate clinical information is used to support quality measures and risk adjustment.
3. MRA (Medical Record Audits):
o Participate in medical record audits to validate and verify diagnosis codes and clinical documentation for risk adjustment.
o Collaborate with healthcare providers to gather complete and accurate medical records for audits.
o Ensure proper coding and documentation to meet CMS and other payer requirements.
4. Utilization Management:
o Review medical requests to ensure that services and procedures are medically necessary and comply with utilization management guidelines.
o Coordinate with healthcare providers and insurance companies to assess the appropriateness of proposed medical treatments and procedures.
o Assist in the review of denials related to medical necessity and assist with appeals as needed.
5. Compliance and Documentation:
o Stay up to date with changes in coding regulations, payer policies, and healthcare laws to ensure compliance with all applicable standards.
o Ensure proper documentation practices are followed for accurate coding, reporting, and billing.
o Communicate effectively with providers, payers, and other stakeholders to resolve issues related to billing, coding, and utilization management.
6. Collaboration:
o Collaborate with the clinical, administrative, and IT teams to ensure that documentation and coding are in alignment with organizational goals and payer requirements.
o Participate in ongoing training and professional development related to billing, coding, HEDIS, MRA, and utilization management.
Qualifications:
• Education:
o High school diploma or equivalent required; Medical Billing & Coding, or related field preferred.
o Certification from a recognized body (e.g., AAPC, AHIMA) as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) is preferred.
• Experience:
o Minimum of 3 years of experience in medical billing and coding.
o Strong experience with HEDIS reporting, MRA audits, and Utilization Management processes.
o In-depth knowledge of ICD-10, CPT, and HCPCS coding systems.
o Previous experience working with risk adjustment programs and CMS regulations is a plus.
• Skills:
o Strong understanding of medical terminology, anatomy, and physiology.
o Proficient in using electronic health records (EHR) and coding software.
o Detail-oriented with strong analytical and problem-solving skills.
o Excellent communication and interpersonal skills.
o Ability to work independently and collaboratively in a fast-paced environment.
Company Description
All's Well Health Care Services is a privately held, diversified service organization comprised of a cohesive team of innovative people dedicated to providing the highest quality healthcare staffing services with the greatest value. We provide cost effective solutions to all levels of healthcare staffing.
All's Well Health Care Services is a privately held, diversified service organization comprised of a cohesive team of innovative people dedicated to providing the highest quality healthcare staffing services with the greatest value. We provide cost effective solutions to all levels of healthcare staffing.
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