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MEDICAL DIAGNOSIS CODER

TPIS -
San Juan, PR

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Job Details

Full-time
$15 an hour

Qualifications

Some college
Spanish
Medical billing and coding data entry
Audit report preparation
ICD-10 Certification
Healthcare documentation compliance audits
Medical billing compliance checks
English
Mid-level
Quality reports
Audit Reporting
Medical billing data reporting
Retrospective medical coding audits
Clinical documentation improvement
Medical Billing Certification
Case referral
Insurance claims auditing
Clinical documentation standards
Associate's degree
Healthcare claims compliance audits
Referral coordination
Documentation review
Under 1 year

Full Job Description

Regular/Non-Exempt Position

Responsible for evaluating CHRA (Comprehensive Health Risk Assessment) forms received from Classicare policyholders and coding the documented clinical information according to the guidelines established by the Unit.

ESSENTIAL FUNCTIONS:

Performs coding of diagnoses documented in the CHRA (Comprehensive Health Risk Assessment) and registers the data into the appropriate application. Identifies and tells the Supervisor about areas of opportunity to avoid errors that reduce rejected data and may represent a risk to compliance with established coding guidelines.
Works on post-payment audits of adjudicated claims based on the information contained in the Comprehensive Health Risk Assessment comparing it to the information required, following the operational guidelines established by the unit.
Generates referrals through the electronic app used in the Unit with providers and/or billing representatives, related to CHRA document management, to guide them and/or request correction of medical diagnoses due to incorrect coding, and inadequate, ambiguous, or incomplete medical documentation.
Processes adjustments received for corrections in the CHRA, following the established operational guidance.
Identifies claims that require the support of the Claims and/or Providers department to be processed.
Provides weekly, monthly, and quarterly reports to the supervisor on audits performed as required.

MINIMUM QUALIFICATIONS:

Two (2) years of college education equivalent to sixty (60) approved credits from an accredited university or an Associate's Degree.
One (1) year of medical billing experience with ICD-9 and ICD10 coding or at least six (6) months of experience performing clinical billing and coding processes.
Knowledge of medical billing processes and ICD-9-CM, ICD-10-CM coding is required.

Certifications/Licenses: Medical billing certification and/or ICD-9, ICD-10, and/or other health-related certifications preferred.

Languages:

Spanish - Intermediate (writing, conversational, comprehension, and reading)

English - Intermediate (writing, comprehension, and reading)

Job Type: Full-time, Permanent Position

Modality:

After 6 months of training, the role may transition to 100% remote.

Schedule:

Monday - Friday rotating schedules from 7:00am - 6:00pm, some Saturdays during high season may be required.

Compensation:

$15.00rph + benefits package.

TPIS is an Equal Opportunity Employer (EEO Employer / Affirmative Action for Females / Disabled / Veterans). We comply with all Federal, State and Local laws regarding nondiscrimination.

Quick Apply

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