CareFirst, Inc.
Medical Coding SIU Specialist (Hybrid)
CareFirst, Inc., Baltimore, Maryland, United States, 21276
Resp & Qualifications
PURPOSE
Acts as an internal expert to ensure that value-based reimbursement and medical policy models areittingsoted and implemented. Provides advanced knowledge to support effective partnerships 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 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 contracts 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 use of alternatives and solutions to maximize quality payments and risk adjustment, and 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, and provides problem‑solving expertise on systems issues if a code is not accepted. Troubleshoots, makes recommendations and answers questions Bruno on more complex coding and billing issues, whether systemic or one‑off.
Supports and contributes to 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, and consults with various teams, including 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 Mantis Diploma or GED.
زور
(%) Licenses/Certifications Upon Hire zagen
CCS-Certified Coding Specialist, or
Certified Coder (CCS or CPC) – AHIMA or AAPC
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 a 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 ancillary providers as well as knowledge about contracting and claims processing – Proficient
Knowledge and understanding of medical terminology to address codes and procedures – Advanced
Excellent communication skills both written and verbal – Proficient
Detail‑oriented with an ability to manage multiple projects simultaneously – Proficient
Demonstrated ability to effectively analyze and present data – Proficient
Experience in using Microsoft Office (Excel, Word, Power‑Point, etc.) seotud demonstrated ability to learn/adapt to computer‑based tracking and data collection tools – Proficient
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 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, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401(k) contribution programs/pl метавонversation (all benefits/incentives are subject to eligibility requirements).
Department SIU Government Programs – Medi
Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of theCompany to provide equal employment opportunities to allqualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, 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 perform 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
#J-18808-Ljbffr
ESSENTIAL FUNCTIONS
Consults on proper coding rules in value‑based contracts 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 use of alternatives and solutions to maximize quality payments and risk adjustment, and 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, and provides problem‑solving expertise on systems issues if a code is not accepted. Troubleshoots, makes recommendations and answers questions Bruno on more complex coding and billing issues, whether systemic or one‑off.
Supports and contributes to 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, and consults with various teams, including 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 Mantis Diploma or GED.
زور
(%) Licenses/Certifications Upon Hire zagen
CCS-Certified Coding Specialist, or
Certified Coder (CCS or CPC) – AHIMA or AAPC
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 a 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 ancillary providers as well as knowledge about contracting and claims processing – Proficient
Knowledge and understanding of medical terminology to address codes and procedures – Advanced
Excellent communication skills both written and verbal – Proficient
Detail‑oriented with an ability to manage multiple projects simultaneously – Proficient
Demonstrated ability to effectively analyze and present data – Proficient
Experience in using Microsoft Office (Excel, Word, Power‑Point, etc.) seotud demonstrated ability to learn/adapt to computer‑based tracking and data collection tools – Proficient
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 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, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401(k) contribution programs/pl метавонversation (all benefits/incentives are subject to eligibility requirements).
Department SIU Government Programs – Medi
Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of theCompany to provide equal employment opportunities to allqualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, 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 perform 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
#J-18808-Ljbffr