Website CES, LLC

Integrity At Work

Job Description Summary: 

CES is looking for a MRS III Coder to perform Medicare comprehensive medical record and claims review to make coding determinations for Medicare MS-DRG as well as CPT-4 and HCPCS Level II claims review coding determinations. Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Part A claims. 



Analyze medical records to validate ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS II coding and MS-DRG assignment on acute inpatient hospital claims as well as outpatient. 
Review codes, diseases, conditions, and procedures on acute inpatient hospital records -Review general clinical documentation to ensure assigned codes are appropriately supported 
Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles 
Utilize electronic health information imaging and input coding review decisions by electronic database module from grouper for inpatient DRG claims. 
Utilize internet and intranet sources for policy verification. 
Utilize Microsoft Office suite and other software templates as associated source input for claims review. 
Meeting quality and production standards. 
Ensuring departmental compliance with quality managements system and ISO requirement 



Required qualifications/skills: 

Must be a Registered Nurse obtained by either a Bachelor’s degree – OR – Associate’s degree – OR – Diploma in Nursing 
Active Certified Coding Specialist (CCS) or Inpatient Hospital Facility Coder (CIC) and preferred as well— one of these certifications: Certified Coding Specialist- Physician based (CCS-P), or Certified Professional Coder (CPC), or Certified Outpatient Coder (COC).  
Minimum of two years of experience in inpatient, acute care coding for Medicare reimbursement 
Must be able to pass a coding test prior to hiring in Part A DRG Medicare inpatient MS-DRG. 


Preferred qualifications/skills: 

MS-DRG assignment experience and encoder experience 
Maintain strict confidentiality to sensitive material 
ICD-10-CM/PCS Coding experience 
Must be able to meet home-office security requirements if approved for remote location. 


Location: Remote from your home office 



Physical Requirements: 

May require prolonged periods of sitting at a desk.