Professional Review Nurse – Certified Professional Coder (CPC)
Direct Hire
Hybrid – 1 day a week in Novi Michigan
Job Details
The Professional Review Specialist provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills to determine appropriateness of medical care.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
- Audit and analyze medical billing inaccuracies and inappropriate charges
- Make decisions regarding appropriateness of billing, delivery of care and treatment plans
- Collaborate with claims examiner/client and or direct reporting manager on claim issues and/or decisions
- Appropriately document work and final conclusions in designated computer program
- Work independently, follow process guidelines, meet productivity standards and timelines. (Must maintain a score of 98% or higher on performance audits)
KNOWLEDGE & SKILLS:
- Certified Professional Coder (CPC) with the America Academy of Professional Coders (AAPC)
- Acute care experience – ICU, CCU, ER, OR, or orthopedics (4 yrs)
- Medical Billing and Coding – C.P.T. and I.C.D.-10 codes and billing protocols (5 yrs)
- Medical Review – medical reports, treatment plans, and billing data for appropriateness of care, treatment duration, and billing accuracy (2 yrs)
- Workers’ Compensation – claims compensation processes, regulations, and medical necessity standards (preferred)
- Computer skills – MS Office Word, Excel, and Outlook
- Tools – Medical review/audit, Documentation systems, Data analytics
EDUCATION & EXPERIENCE:
- CPC – required
- Associate’s degree in healthcare
- RN/LPN preferred with Michigan active license
Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, pleas e visit our website at www.optechus.com.
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/