Clinical Consultant - Clinical Dispute Resolution and Coding

Location

Arlington, TX | United States

Job description

Job Requisition: Clinical Consultant - Clinical Dispute Resolution and Coding

Job Summary: The Clinical Consultant will play a pivotal role in supporting clinical review projects and managing the clinical coding associated with those contracts. The ideal candidate will bring extensive clinical expertise, a deep understanding of independent medical review processes, and a proven history in clinical coding.

Key Responsibilities:

1. Clinical Review Support:
   • Participate in clinical review projects, working closely with cross-functional teams to analyze and resolve clinical disputes efficiently.
   • Participate and conduct state hearings as needed in support of assigned projects.
   • Collaborate with legal and compliance teams to ensure adherence to regulations and contractual obligations during dispute resolution processes.
2. Clinical Coding:
   • Oversee and manage the clinical coding processes related to projects, ensuring accuracy and compliance with industry standards.
   • Provide guidance to coding teams and contribute to continuous improvement initiatives in clinical coding practices.
3. Documentation and Reporting:
   • Maintain comprehensive documentation of clinical review resolution activities, ensuring a clear and auditable trail of actions taken.
   • Generate regular reports on clinical coding accuracy, clinical review outcomes, and key performance indicators for senior management.
4. Collaboration and Communication:
   • Collaborate effectively with internal stakeholders, including legal, compliance, finance, and operational teams.
   • Communicate with external parties, including clients and regulatory bodies, to address clinical coding and dispute resolution matters.

Qualifications:

• Minimum of 10 years of experience in a clinical review role, with a focus on medical review and clinical coding.
• Bachelor’s degree in nursing required.
• Current CPC coding certification is a plus.
• Strong knowledge of Industry Standards and regulations related to clinical coding and review.
• Excellent communication and interpersonal skills.
• Proven ability to lead and collaborate in a cross-functional team environment.

Job tags

Salary