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Certified Professional Coder - HMS-Columbus

Columbus, Ohio; Maumee, Ohio; Cleveland, Ohio; Wheeling, West Virginia
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Description

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

 

Position Summary

Employee is a certified coder who assists in and provides support for HMS’ provider bill processing operations to ensure appropriate provider payments are made in compliance with HMS/Ohio Bureau of Workers’ Compensation contract and the procedures set forth in the MCO Policy Reference Guide. Employee must utilize certification expertise to assess complicated coding and billing issues.

 

Accountabilities

1. Understands and complies with Ohio BWC Guidelines as set forth in the MCO Policy Reference Guide and Ohio BWC Billing and Reimbursement Manual. 
2. Completes prospective, concurrent and retrospective reviews for inpatient hospital admissions. 
3. Audits provider bills for accurate coding. 
4. Proficient in CPT and ICD coding and can identify appropriate utilization of codes. 
5. Perform bill review process beginning with data entry and resulting in the approval/denial of services. 
6. Utilizes certification to identify services that meet the Miller criteria and makes the decision to override or deny payment. 
7. Analyze the billing form in conjunction with the billing codes and C-9 authorizations. 
8. Utilize clinical editing software. 
9. Discuss billing issues internally with team members and/or with providers, employers and injured workers via oral and written communication. 
10. Other duties as assigned. 
 


  • Education: High school diploma 
  • Skills: Experience using Microsoft Office programs, especially Excel, Word, PowerPoint, and Access. Exceptional written, telephonic, and oral communications, leadership, problem-solving, interpersonal, and organizational skills. Ability to coordinate multiple priorities. 
  • Certification: One of the following: Registered Health Information Administrator (RHIA®), Registered Health Information Technician (RHIT®), Certified Coding Associate (CCA®), Certified Coding Specialist – Physician-based (CCS-P®), Certified Coding Specialist (CCS®), Certified Professional Coder® (CPC®), Certified Professional Coder-Payer (CPC-P®), Certified Inpatient Coder (CIC™), or Certified Outpatient Coder (COC™). 

 

Preferred Qualifications

  • Education: Associate degree preferred and/or minimum (2) - years experience with Ohio BWC billing. 
  • Skills: Knowledge of medical terminology and processes including medical coding

 

 

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

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