Outpatient Coding Product Manager
MedReview Inc.
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $100,000 - $110,000 per year
Job Level
Mid-LevelSenior
Tech Stack
PythonSQL
About the role
- Provide subject matter expertise in outpatient hospital and professional reimbursement methodologies, especially including APC, EAPG, and other grouper-based methodologies.
- Review and interpret client guidelines and policy, provider contract language, and State and Federal regulations to identify audit opportunities.
- Develop, refine, and validate audit concepts and payment integrity rules to identify inappropriate billing and resulting payment errors.
- Collaborate with product, data analytics and technology teams to design and test outpatient claim selection logic.
- Analyze large volumes of claims data to identify coding trends, billing patterns, and emerging opportunities for new audits.
- Interpret and apply CMS and payer guidelines to ensure regulatory compliance and alignment with current coding standards.
- Support product development initiatives by providing clinical and coding insight throughout the product lifecycle.
- Assist with documentation, training materials, and validation testing for new and updated audit concepts.
- Champion training for auditors and coders to ensure consistent application of outpatient audit methodologies.
- Review audit findings for selection accuracy and to ensure alignment with regulatory and payer policies.
- Provide input on operational workflows and documentation standards to improve audit efficiency and quality.
- Monitor and communicate regulatory updates affecting outpatient reimbursement.
- Prepare and present findings, reports and recommendations to internal stakeholders.
Requirements
- Coding Certification is required.
- RHIT, Certified Outpatient Coder (COC), or similar certification preferred.
- Certified Professional Coder (CPC) or Apprentice Certified Outpatient Coder (COC-A) accepted.
- Strong analytical and data comprehension skills are required.
- SQL or Python coding experience is desirable.
- Additional clinical background is preferred but not required.
- At least 5 years of experience in hospital outpatient coding required.
- Surgical coding is particularly desirable.
- Extensive expertise with various outpatient reimbursement methodologies.
- Knowledge of all payer types including Medicare, Medicaid, and Commercial plans.
- Prior experience in payment integrity and audit development strongly preferred.
- Familiarity with data analytics and audit selection processes.
Benefits
- Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
- 401(k) with Employer Match - Join the team and we will invest in your future
- Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
- Wellness - We care about your well-being. From Commuter Benefits to FSAs, we’ve got you covered.
- Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
outpatient codingAPC methodologiesEAPG methodologiesaudit developmentpayment integritySQLPythonsurgical codingdata analyticsbilling patterns
Soft skills
analytical skillsdata comprehensioncollaborationtrainingcommunicationdocumentationpresentation skillsattention to detailproblem-solvingoperational efficiency
Certifications
Coding CertificationRHITCertified Outpatient Coder (COC)Certified Professional Coder (CPC)Apprentice Certified Outpatient Coder (COC-A)