Medical Coder

Description & Requirements

Maximus is looking for a Remote Medical Coder. The Medical Coder Position will administer and process all incoming medical records and lay evidence included with a proposal to ensure correct documents are provided to the WCMSA reviewer.

Essential Duties and Responsibilities :

• Administer and process all incoming medical records and lay evidence included with a proposal.
• Ensure correct documents are provided to the reviewer.
• Review documents determining completeness and eligibility prior to assigning to the reviewer.
• Examine case file to ensure all relevant information has been submitted.
• Contact appropriate parties for required documents and / or clarification, if not received.
• Succinctly summarize the facts for each case for the reviewer indicating what medical evidence is present supporting the set-aside proposal.
• Work closely with SMEs to develop and implement internal procedures, policy communications, work flows, QC documents, training materials and job aids.
• Administer and process all incoming medical records and lay evidence included with a proposal
• Ensure correct documents are provided to the WCMSA reviewer
• Examine case file to ensure all relevant information has been submitted
• Contact appropriate parties for required documents and / or clarification, if not received
• Succinctly summarize the facts for each case for the WCMSA reviewer indicating what medical evidence is present supporting the set-aside proposal
• R- Work closely with SMEs to develop and implement internal procedures, policy communications, work flows, QC documents, training materials and job aids
• Meet all standards established for this position
• Support mailroom and scanning activities to include the following : inbound mail processing, outgoing mail, image reconciliation, and image processing on an as needed basis
• Collect and record data for mailroom and scanning activities

Minimum Requirements

• High School diploma or equivalent with 1-2 years of experience.
• Associate degree preferred.
• High school diploma or GED required
• Associates degree or higher from an accredited college or university preferred
• At least one (1) year of experience working in medical review environment preferred
• At least two (2) years of experience working in healthcare or legal-related field preferred
• Experience with Workers Compensation or Medicare regulations, guidelines and coverage issues preferred
• Experience handling inquires, complaints and issues
• Experience with medical necessity or utilization review determinations at any level within healthcare preferred
• Knowledge of scope of practices for all types of medical professionals
• Competent problem-solving and analysis skills
• Computer literacy with knowledge of Microsoft Outlook, work processing and spreadsheet software
• Excellent organizational, interpersonal, written, and verbal communication skills
• Ability to perform comfortably in a fast-paced, deadline-oriented work environment
• Ability to successfully execute many complex tasks simultaneously
• Ability to work as a team member, as well as independently with minimal supervision
• Ethical conduct and strategic thinking abilities

Home Office Requirements :

• Hardwired internet (ethernet) connection
• Internet download speed of 25mbps and 5mbps (10 preferred) upload or higher required (you can test this by going to www.speedtest.net)
• Private work area and adequate power source

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce.

We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country.

We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.

A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action / Equal Opportunity Employer.

Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor.

That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation.