Healthcare Coding Analyst

Blue Cross Blue Shield of Minnesota•Eagan, MN

11h•$67,200 - $111,000•Hybrid

About The Position

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have Blue Cross and Blue Shield of Minnesota is hiring multiple Healthcare Coding Analyst in Eagan, MN. In this role, you will be responsible for ensuring healthcare medical coding and reimbursement policies are implemented and integrated in all systems for accurate claims adjudication. This includes analysis of changes to medical code sets to determine impacts to and necessary changes of current policies, assisting with data analysis and reporting needs related to coding policy decisions, and reviewing medical records to validate provider coding. The incumbent will also represent the medical coding team on various Blue Cross project teams. The ideal candidate will have 3 years of prior coding experience and a certification in CPC, CCS, CCS-P, or RHIT.

Requirements

2+ years' related experience or Bachelor’s degree. All relevant experience including work, education, transferable skills, and military experience will be considered.
3 years of relevant health plan or provider office medical coding/claims and/or Business Analyst experience in a healthcare setting applicable to claims/coding
Have at least one of the following credentials – CPC, CCS, CCS-P, RHIT
Incumbent is expected to enroll in continuing education courses to maintain certification.
Ability to apply critical thinking skills to coding policy interpretation and implementation.
Ability to work independently; well-organized and able to set priorities with minimal direction.
Ability to effectively communicate both verbally and in writing.
Strong PC skills; Excel, Word, PowerPoint and internet based programs.
Ability to maintain relationships with internal and external stakeholders, coding experts, and others.
High school diploma (or equivalency) and legal authorization to work in the U.S.

Nice To Haves

Associates degree.

Responsibilities

Conduct in-depth research and analysis of appeals data and processes to identify trends and emerging issues, and recommend best practices for maximum performance.
Research and recommend resolution and/or prepare written response for provider related coding appeals assuring that federally and state mandated coding rules are followed and that the medical documentation supports such coding.
Provide recommendations to leadership to modify reference materials and processes that do not fully satisfy regulatory or legal compliance related to coding.
Provide recommendations to modify materials and processes that do not accurately follow our internal policies and contracted agreements or that have proven to be confusing or ineffective.
Complete follow-up activities to reflect change for compliance.
Assist in communicating changes in Blue Cross coding and reimbursement policies to all lines of business, internal business teams and contracted providers.
Maintain Blue Cross Provider Policy and Procedure Manual relative to coding policy decisions and related reimbursement.
Serve as a liaison to other divisions/departments (Health Management, Service, Claims) for coding policy and coding/payment issues.
Directs and coordinates activities of designated coding projects through the project life cycle including the needs assessment, project initiation, design, development and implementation.
Serve as a knowledge expert related to medical coding.
Participate as a team member of cross-departmental committees ( e.g. Coding and Reimbursement, RICHIE, NAG, I-team).