Benefits Coding Analyst

Sentara Health•Richmond, VA

1d•Remote

About The Position

Sentara Health is looking to hire a Remote Benefits Coding Analyst. This position is remote however, candidates must be able to commute to our Richmond location. The Benefits Coding Analyst – Certified Professional Coder maintains the integrity of the plan benefits for each program and is responsible for developing an extensive expertise of all plan benefits. The Benefits Coding Analyst will work closely with multiple teams across the Health Plan, including but not limited to Claims, Compliance, Program, IT, and Health Services/Medical Management to ensure benefits are compliant with state and Federal guidelines, as well as aligned with Program benefit offerings. This position is responsible for synthesizing the input from multiple stakeholders to inform significant business decisions regarding benefit implementation as well as coordinating and maintaining benefit design documentation for the organization. The Benefits Coding Analyst will research, code, and assist with the development of benefit and utilization review policies and criteria for emerging treatments, technology, medications, and health plan services. This role will assist in researching code updates, authorization requests, and claim questions, updating business rules and benefit repositories as appropriate.

Requirements

2+ years of medical coding or billing experience specifically within reimbursement, coding, claims processing, claims auditing and /or various payment methodologies (required)
Thorough knowledge of anatomy and medical terminology
Expertise with NCCI (National Correct Coding Initiative) guidelines
Knowledge or direct experience processing Government program or commercial health claims for an MCO
Experience with ICD-10 CM, CPT, HCPCS, QNXT
Certified Professional Coder certification (CPC) (required)
Associate Degree in Healthcare (preferred)

Nice To Haves

Experience in both established benefit coding environments as well as experience in determination of coding requirements for new benefits (preferred)
Experience resolving billing and claims issues related to benefit to code assignment.
Certified Inpatient Coder (CIC) (preferred)
Medical Assistant Certification (preferred)

Responsibilities

maintains the integrity of the plan benefits for each program
developing an extensive expertise of all plan benefits
synthesizing the input from multiple stakeholders to inform significant business decisions regarding benefit implementation
coordinating and maintaining benefit design documentation for the organization
research, code, and assist with the development of benefit and utilization review policies and criteria for emerging treatments, technology, medications, and health plan services
researching code updates, authorization requests, and claim questions, updating business rules and benefit repositories as appropriate

Benefits

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.