Claims Coding Coordinator

WVU Medicine

84d

About The Position

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Come join Peak Health to help design and build a health plan from the ground up as our Medical Coding Coordinator for the claims department. Reporting to the Claims Manager, the Medical Coding Coordinator will be an integral member of the health plan’s claims processing team. The Medical Coding Coordinator is a collaborative member of the Claims Processing operational team. The incumbent will be an excellent communicator who has high acumen in medical claims coding and diagnostics pairing. This role will be relied on for claims coding review for accuracy in both commercial and Medicare Advantage lines of business.

Requirements

• High school diploma or equivalent.
• Certified Coding Specialist (CCS), Certified Professional Coder-Apprentice (CPC-A) or Certificated Professional Coder (CPC) certification.
• One (1) year of health insurance claims related experience.
• Three (3) years of healthcare related experience.

Nice To Haves

• Three years of monitoring, evaluating audit progress, reporting and work prioritization within cross functional teams.
• Advanced acumen of ICD 10 and diagnostics coding.

Responsibilities

• 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.
• 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.
• Responsible for quality assurance reviews that require coding input. Ensure that coding is compliant with CMS coding guidelines and other enterprise coding guidelines for claims processing.
• Participate and lead any type of regulatory claims audits, internal and external, regarding claims processing and payment.
• Process both commercial and Medicare claims to adjudication accurately.
• Manage, review, and maintain CES claims edits in the Optum edit system.
• Create and maintain edit reporting documents, tracking issues and errors for correction.
• Maintain and create accurate, detailed, researched documentation on edit maintenance in accordance with CMS guidelines.
• Meets or exceeds all production and quality standards, maintaining work queues according to department standards.
• Other duties as assigned by management.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees