Manages the claims coding rule process and evaluates coding rule change requests from clinical, financial, and claims operations perspectives.
Provides regulatory and correct-coding research on change requests and makes recommendations on payment policy and edit functionality.
Defines requirements and partners with vendors throughout testing and implementation.
Supports provider dispute and appeal teams, researches claims coding rule initiatives, maintains rule libraries, documents supporting authority, and participates in cross-functional teams to address coding rule issues.
Administers communication to the network, collects feedback, investigates escalated provider disputes, supports claims/configuration/dispute teams as needed, and manages high-visibility projects by providing recommendations and status updates to leadership.
Researches, analyzes, and presents savings opportunities to leadership.
Required experience
- 5+ years of experience in the medical coding field with a facility, provider, or payer organization
- Claims work experience
Preferred education
- Associate degree preferred, though a combination of education and experience will be considered
Knowledge and skills
- Knowledge of CMS and state laws and AMA guidance
- Advanced user knowledge of claims payment systems
- Knowledge of 3M Encoder
- Strong knowledge of electronic medical records, billing systems, medical terminology, and abbreviations
- Billing expertise in UB-92, 1500, and other healthcare services
- Knowledge of one or more of the following: SQL, Xcelys, CES, iHT
- Strong written communication, leadership, interpersonal, verbal communication, teamwork, and problem-solving skills
Certifications
- CCS - Certified Coding Specialist
Compensation and perks
- Eligible for short-term incentives
- Comprehensive benefits package
- Health, life, voluntary, and other benefits and perks that support physical, mental, emotional, and financial wellbeing
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Salary Range
$58,440 - $93,500
Remote work allowed
No
Posted
1 month ago