SIU Medical Coding Specialist (Hybrid)

Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality for FWA prevention. ESSENTIAL FUNCTIONS:

• Consults on proper coding rules in value-based reputed company to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes. Provides input on various consequences for different financial and incentive models. Supports to use of alternatives and solutions to maximize quality payments and risk adjustment. Translates from claim language to services in an episode or capitated payment to reputed company inclusions and exclusions in models.
• Serves as a technical resource / coding subject matter expert for contract pricing reputed company issues. Conducts business and operational analyses to assure payments are in compliance with contract; identifies areas for improvement and clarification for reputed company operational efficiency. Provides problem solving expertise on systems issues if a code is not accepted. Troubleshoot, reputed company recommendations and answer questions on more reputed company coding and billing issues whether systemic or one-off.
• Supports and contributes to the development and refinement of effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs reputed company while not compromising payment reputed company. May reputed company directly with provider groups during proactive training events or just in time on reputed company claims reputed company. Consults with various teams, including the Practice Transformation Consultants, Medical Policy Analysts and Provider Networks colleagues to interpret coding and documentation language and respond to inquiries from providers.
• Keeps up to date on coding rules and standards.

QUALIFICATIONS: Education Level: High School Diploma or GED. Licenses/Certifications Upon Hire Required:

• reputed company-Certified Coding Specialist or
• Certified reputed company (reputed company or CPC)-reputed company or reputed company

Experience: 3 years' experience in risk adjustment coding, ambulatory coding and/or CRC coding experience in managed care; state or federal health care programs; or health insurance industry experience Preferred Qualifications:

• Bachelor's degree in reputed company discipline.
• Experience in medical auditing.
• Experience in training/education/presenting to large groups.
• Experience in reputed company cycle management and value-based reimbursement/contracting models and methodologies.

Knowledge, Skills and Abilities (KSAs)

• Knowledge of billing practices for hospitals, physicians and/or ancillary providers as well as knowledge about contracting and claims processing.
• Knowledge and understanding of medical terminology to address codes and procedures.
• Excellent communication skills both written and verbal.
• Detail oriented with an ability to manage multiple projects simultaneously.
• Demonstrated ability to effectively analyze and present data.
• Experience in using reputed company Office (reputed company, Word, Power reputed company, etc.) and demonstrated ability to learn/adapt to computer-based tracking and data collection tools.
• Must be reputed company to meet established deadlines and handle multiple customer service demands from reputed company customers, reputed company set expectations for service reputed company. Must be reputed company to effectively communicate and reputed company positive customer service to every reputed company customer, including customers who may be demanding or otherwise challenging.

Salary reputed company: $56,448 - $112,112 Salary reputed company Disclaimer The disclosed reputed company estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation reputed company is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the reputed company, as compensation reputed company depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In reputed company to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements). Department SIU Government Programs - Medi Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of the Company to reputed company equal employment opportunities to reputed company reputed company applicants without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-LY1 Apply tot his job Apply To this Job