CareFirst BlueCross BlueShield
Senior Medical Coding Specialist (Remote)
CareFirst BlueCross BlueShield, Baltimore, Maryland, United States, 21276
Senior Medical Coding Specialist (Remote)
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Senior Medical Coding Specialist (Remote)
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CareFirst BlueCross BlueShield Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides expert knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT, HCPCS, and ICD 10 codes in claims submissions. Responsibilities and Qualifications Utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge to build the 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. Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT, HCPCS, and ICD10 codes. Serves as a technical resource / coding subject matter expert for contract pricing related issues. Develops and refines effective guides and resources for providers on the expected methodologies for billing and code submissions. Participates in strategy and contributes to thought leadership for quality measure capture (NCQA, HEDIS, STARs). Facilitates mentorship, providing assistance to less seasoned team members. Actively researches industry trends, keeping up-to-date and maintaining a high level of expertise in coding rules and standards. Qualifications Education Level:
High School Diploma or GED. Experience:
5 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. Bachelor's degree in related discipline Certified public accountant Experience in medical auditing Experience in training/education/presenting to large groups 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. Experience in revenue cycle management and value-based reimbursement/contracting models and methodologies. Detail-oriented with an ability to manage multiple projects simultaneously. Excellent communication skills both written and verbal. Demonstrated ability to effectively analyze and present data. Ability to create educational materials, training manuals, and/or procedural guides. Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and demonstrated ability to learn/adapt to computer-based tracking and data collection tools. Licenses/Certifications Upon Hire Required CCS-Certified Coding Specialist Certified Coder (CCS or CPC)-AHIMA or AAPC CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
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Join to apply for the
Senior Medical Coding Specialist (Remote)
role at
CareFirst BlueCross BlueShield Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides expert knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT, HCPCS, and ICD 10 codes in claims submissions. Responsibilities and Qualifications Utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge to build the 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. Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT, HCPCS, and ICD10 codes. Serves as a technical resource / coding subject matter expert for contract pricing related issues. Develops and refines effective guides and resources for providers on the expected methodologies for billing and code submissions. Participates in strategy and contributes to thought leadership for quality measure capture (NCQA, HEDIS, STARs). Facilitates mentorship, providing assistance to less seasoned team members. Actively researches industry trends, keeping up-to-date and maintaining a high level of expertise in coding rules and standards. Qualifications Education Level:
High School Diploma or GED. Experience:
5 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. Bachelor's degree in related discipline Certified public accountant Experience in medical auditing Experience in training/education/presenting to large groups 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. Experience in revenue cycle management and value-based reimbursement/contracting models and methodologies. Detail-oriented with an ability to manage multiple projects simultaneously. Excellent communication skills both written and verbal. Demonstrated ability to effectively analyze and present data. Ability to create educational materials, training manuals, and/or procedural guides. Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and demonstrated ability to learn/adapt to computer-based tracking and data collection tools. Licenses/Certifications Upon Hire Required CCS-Certified Coding Specialist Certified Coder (CCS or CPC)-AHIMA or AAPC CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
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