Claims Coding Coordinator- Peak Health

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate degree in healthcare related field or High school diploma or equivalent AND Certified Coding Specialist (CCS) or Certificated Professional Coder (CPC) certification.

EXPERIENCE:

1. One (1) year of health insurance claims related experience.

2. Three (3) years of healthcare related experience.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Three years of monitoring, evaluating audit progress, reporting and work prioritization within cross functional teams.

2. Advanced acumen of ICD 10 and diagnostics coding

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Conducts ongoing data analysis from medical record reviews to identify opportunities to improve provider documentation and coding for members regarding assignment of ICD-10CM codes to chronic conditions.

2. Participate in regulatory audit training from regulatory agencies such as AHIMA as well as other agencies to ensure that current processes are aligned with best practice.

3. Responsible for quality assurance reviews that require coding input. Ensure that coding is complaint with CMS coding guidelines and other enterprise coding guidelines for claims processing.

4. Participate and lead any type of regulatory claims audits, internal and external, regarding claims processing and payment.

5. Process both commercial and Medicare claims to adjudication accurately.

6. Manage, review, and maintain CES claims edits in the Optum edit system.

7. Create and maintain edit reporting documents, tracking issues and errors for correction.

8. Maintain and create accurate, detailed, researched documentation on edit maintenance in accordance with CMS guidelines.

9. Meets or exceeds all production and quality standards, maintaining work queues according to department standards.

9. Other duties as assigned by management.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Sitting and working on a computer for several hours a day.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

SKILLS AND ABILITIES:

1. Excellent written and oral communication with internal and external partners.

2. Independent document assessment and excellent time management skills.

3. High Attention to detail and organizational skills.

4. Proficiency in Epic Tapestry software.

5. Proficiency with Microsoft Office Suite and associated applications.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

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