Project Coordinator - Medical Policy UMC Coder (Hybrid - Troy, MI) - Health Alliance Plan

GENERAL SUMMARY:

As an integral member of the HAP Medical Policy Team, the Project Coordinator will be responsible for research and guidance on coding such as CPT, HCPCS, ICD used in the development and maintenance of Benefit Administration Manual policies and HAP's coverage tool (Master Tiering Database) as well as actively participate in various HAP code-related committees and ad hoc projects.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Conduct research for development and update of codes for Benefit Administration Manual policies and the Master Tiering Database, requests by the Utilization Management Committee and HAP code-related committees, and other issues such as new technology. Maintain organized documentation of findings from research as well as proposed resolutions.
• Research all types of codes (e.g., CPT, HCPCS, ICD) including new codes, existing codes, additions and deletions of codes, use of modifiers, and revenue codes to be compliant with Medicare rules and regulations, the Medicare Billing Manual, the American Medical Association, or any adopted resource used in Benefit Administration Manual policies and the Master Tiering Database as needed and on a quarterly or yearly basis.
• Assist with preparing draft Benefit Administration Manual (BAM) policies with correct codes ensuring that all Medicare covered codes are found on the BAM, new codes are on the correct BAM, and codes are aligned with benefit coverage and contractual obligations.
• Participate in Medical Policy Team and HAP code-related committee meetings to resolve coding questions related to claims, configuration, benefits, new technology, fraud, compliance, and any other issue. Aside from committee meetings, assist with claims resolution issues as needed.
• Assist in requesting and tracking any system configuration changes completed by the Benefit Configuration Team (BCT) and work with BCT on coding changes approved by the Utilization Management Committee or leadership.
• Work with the Medical Policy Team on communications issues related to compliance, billing, new procedures codes, or other matters for inclusion in interdepartmental documents.
• Provide ad hoc research and guidance for special projects as needed.
• Maintain/enhance professional and technical knowledge through educational workshops and reviewing professional publications as it pertains to Benefit Administration Manual policies, claims processing decisions, and coding credentials.

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.