SIU Medical Coding Specialist; Hybrid

Position: SIU Medical Coding Specialist (Hybrid)
** Resp & Qualifications*
* *
* PURPOSE:

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* 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.

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* ESSENTIAL FUNCTIONS:

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* + Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD
10 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 articulate inclusions and exclusions in models.

+ Serves as a technical resource / coding subject matter expert for contract pricing related issues. Conducts business and operational analyses to assure payments are in compliance with contract; identifies areas for improvement and clarification for better operational efficiency. Provides problem solving expertise on systems issues if a code is not accepted. Troubleshoot, make recommendations and answer questions on more complex 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 outcomes while not compromising payment integrity. May interface directly with provider groups during proactive training events or just in time on complex claims matters. 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.

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* QUALIFICATIONS:

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* ** Education Level:
** High School Diploma or GED.

** Licenses/Certifications Upon Hire

Required:

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* + CCS-Certified Coding Specialist or

+ Certified Coder (CCS or CPC)-AHIMA or AAPC

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* 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

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* Preferred Qualifications:

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* + Bachelor's degree in related discipline.

+ Experience in medical auditing.

+ Experience in training/education/presenting to large groups.

+ Experience in revenue 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 Microsoft Office (Excel, Word, Power Point, etc.) and demonstrated ability to learn/adapt to computer-based tracking and data collection tools.

+ Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

** Salary Range:**  $56,448 - $112,112

** Salary Range Disclaimer*
* The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range 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 range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.

In addition to your compensation, Care First offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

** Department*
* SIU Government Programs - Medi

** Equal Employment Opportunity*
* Care First Blue Cross Blue Shield is an Equal Opportunity…