Job summary
Job post source
This job is directly from Pivotal Solutions
Job overview
The Medical Coding Compliance and Audit Specialist at Pivotal Solutions ensures accurate and compliant medical billing and coding, improving efficiency and reducing fraud risk within the company.
Responsibilities and impact
The specialist monitors and audits patient accounts, develops expertise in Medicare and Medicaid billing policies, researches compliance issues, educates staff on policy changes, assists in maintaining billing procedures, coordinates training programs, performs audits, and analyzes billing trends to minimize errors.
Experience and skills
Requires a High School Diploma or GED, Certified Professional Coder (CPC) certification, with Certified Professional Medical Auditor (CPMA) preferred, at least five years of medical claim management experience, advanced knowledge of medical terminology, insurance billing, coding standards, EHR systems, and intermediate Microsoft Excel skills.
Work environment and culture
The company culture emphasizes service with compassion, respect, trust, integrity, innovation, education, fiscal responsibility, independence, accountability, and empowerment, fostering meaningful connections and positive change.
Job location and travel
The work environment is an office/clinic setting with physical demands including sitting, standing, walking, and occasional lifting consistent with office environments.
Company overview
Pivotal Solutions is a technology consulting firm specializing in providing innovative IT solutions and services to businesses across various industries. They generate revenue through consulting fees, managed services, and custom software development projects. Founded in 2005, the company has grown significantly, establishing a reputation for delivering high-quality, scalable technology solutions that drive business growth and efficiency. Key milestones include their expansion into international markets and the development of proprietary software tools that enhance client operations.
How to land this job
Position your resume to highlight your expertise in medical coding compliance, audit processes, and billing efficiency improvement, aligning with Pivotal Solutions' focus on reducing fraud and enhancing service quality.
Emphasize your knowledge of Medicare, Medicaid, commercial insurance billing policies, and your experience with CPT, ICD-10, HCPCS coding, and Evaluation and Management (E/M) coding as these are crucial for this role.
Apply through multiple channels, including Pivotal Solutions' corporate career site and LinkedIn, to maximize your application visibility and chances of being noticed for the Medical Coding Compliance and Audit Specialist position.
Connect on LinkedIn with professionals in Pivotal Solutions' Business Services, Billing, and Compliance divisions; use ice breakers like asking about recent updates in billing policies they’ve implemented or inquiring how their team handles audit challenges.
Optimize your resume for ATS by incorporating keywords from the job description such as 'medical coding compliance,' 'audit,' 'Medicare and Medicaid billing,' 'CPC,' 'CPMA,' 'EHR,' and 'billing policies' to ensure it passes automated screenings effectively.
Leverage Jennie Johnson's Power Apply feature to automate tailored applications, identify multiple application portals, and find relevant LinkedIn contacts, enabling you to focus your energy on preparing for interviews and networking.
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