An Outpatient Coder is responsible for reviewing international medical records and invoices to assign codes for diagnoses and procedures performed so services can be presented to insurances companies. Claims coding specialist will also analyze medical invoices to determine whether they quality for payment and review for possible suspicion of fraud.
• Reviews claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission
• Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines
• Maintains compliance with all company policies and procedures
• Reviews invoices from international providers and assigns accurate US code for services
• Review claims to determine if costs were reasonable for the service performed
• Processes claims by entering patient, payment and provider information timely and accurately
• Identify and correct any and all duplicate claims received
• Conducts medical record research and examines other claims to obtain detailed information needed to accurately process the claim
• Understands the differences between international and US coding standards
• Utilizes specialized medical classification software (MAG) to assign procedure and diagnoses codes for insurance billing.
• Verifies diagnosis codes for each medical condition have been captured and submitted with the permitted timeframe
• Eliminates any diagnosis code that is unsubstantiated
• Process claims with a high level of productivity (average 53 claims per day) and minimum average accuracy levels (Procedural accuracy of 97.0% and Transmission accuracy of 97.0%) in accordance with all departmental standards
• Convert Foreign currency into United States Dollar
• Complete other tasks, as assigned
Quickly adapting and gaining a sound understanding of the different coding standards between international and us coding.
Education, Experience, and Knowledge / Skills / Abilities
Minimum Education Requirements:
• High School Diploma/GED
• Is either CPC, or CPR-H, CCS-P CCS Certified (active status)
• A minimum of 1 year of previous coding experience in a hospital and/or doctor's office
• Six months to one year of experience with medical claims examiner knowledge
Knowledge, Skills, and Abilities
• Familiar with CPT, HCPCS, ICD-9 and ICD – 10 code sets
• Working knowledge of anatomy, medical and procedural terminology
• Knowledge of medical billing practices
• Computer proficiency (MS Office Suite and Outlook)
• Understanding and ensures compliance of HIPAA laws and regulations
• Able to differentiate between primary and secondary insurance payers
• Excellent interpersonal skills
• Excellent verbal and written communication skills
• Must be well organized and detail-oriented
• Must be able to work extended hours when necessary
• Able to work in a team environment
• Type minimum 35 wpm
• Strong 10 key skills by touch
• Able to adapt and apply additional training initiatives
• Able to differentiate between international and domestic coding guidelines
Preferred Education, Knowledge, Skills and Abilities:
• Associates Degree
• Previous Claims Examiner experience
NOTE: AXA participates in the E-Verify program.
In addition to competitive compensation and an outstanding benefits package including 401 (k) and medical programs, we offer the opportunity for continued professional development in a congenial corporate environment.
AXA is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.
AXA Assistance is a worldwide leader in emergency travel assistance and has grown to 38 offices around the globe. Services now include emergency medical assistance, managed care, concierge and travel services. Regardless of how our company has grown, our business focus remains the same: to best use the knowledge and customer service skills of our employees to exceed the expectations of our clients.