Medical Coder (CPC-A)

Develops, updates and maintains clinical content for the InterQual Medicare products. This role is responsible for the comprehensive analysis, development and maintenance of clinical content supporting the InterQual 3rd party content (e.g., CMS LCDs/NCDs) that is used to perform a medical necessity review. Content developer is responsible for interpreting 3rd party content and updating existing content and developing new content as requested. Clinical content development includes but is not limited to updating existing rule-based algorithms and/or creating new algorithms that accurately reflects the 3rd -party content including applicable CPT codes, ICD-10-CM diagnosis codes (if required), and HCPCS codes. Other codes sets may be identified based on the content.

Education/Training

Associate’s degree requiredBachelor’s degree preferredCurrent licensure/certification in health-related field preferred

Business Experience

At least 3 years working in a health-related field; clinical role, clinical documentation specialist, medical coding, medical research or medical claims adjusterKnowledge of standard medical code sets; ICD-10, CPT, HCPC required. SNOMED-CT, LOINC preferred

Specialized Knowledge/Skills

Excellent organizational, communication, and project management skillsStrong computer skills in basic Office applications (Word, Excel, Outlook, etc.)Strong knowledge of medical terminologyStrong attention to detailAbility to successfully manage multiple priorities with deliverables completed on time and with high qualityAbility to learn new workflow tools