Implement & Coding Consultant

Elevance Health•Tampa, FL

10d•$78,800 - $135,929•Hybrid

About The Position

The Implement & Coding Consultant leads the development, implementation, and evaluation of Corporate Medical Policy coding strategies across the enterprise. The role develops implementation approaches that account for enterprise and regional business objectives, adjudication systems, benefit design, and regulatory differences. It evaluates implementation and coding options and recommends approaches that balance clinical, coding, systems, cost, and provider-relations considerations. The consultant works with clinical and operations stakeholders to communicate and monitor policy implementation, supports medical policy and clinical utilization-management guideline development and review by creating and maintaining coding sections, and provides support to the Medical Policy Research team. The role also oversees coding quality assurance, tracks coding updates, responds to coding inquiries, supports departmental meetings and document management, improves implementation processes, and facilitates resolution of local implementation issues.

Requirements

BA/BS degree and a minimum of 5 years of related medical policy experience, including prior experience leading large, multi-stakeholder regional or enterprise projects; or an equivalent combination of education and experience.
Experienced reviewing clinical criteria and assigning codes according to coding guidance (highly preferred).

Nice To Haves

Certified Professional Coder (CPC) certification (strongly preferred).
Experience reviewing clinical criteria and assigning codes according to coding guidance (highly preferred).

Responsibilities

Conceptualize implementation approaches that address enterprise and regional business objectives, adjudication systems, benefit design, and regulatory environments.
Assess business and technical factors, evaluate implementation and coding options for specific policies, and recommend an optimal approach.
Optimize enterprise policy implementation solutions by balancing clinical, coding, systems, cost, and provider-relations considerations.
Communicate and monitor policy implementation in collaboration with clinical and operations stakeholders in business units.
Create and maintain the Coding sections of enterprise medical policies and clinical UM guidelines as part of their development and review process.
Provide support to the Medical Policy Research team.
Develop quality assurance processes for accurate code assignment on policies and translation within adjudication systems.
Compile and classify quarterly coding updates from CMS and the AMA, and communicate coding updates related to MPTAC decisions through department tools and communications.
Conduct coding analysis and respond to internal business partners’ coding inquiries, including coverage of a shared mailbox.
Manage materials for weekly Coding & Implementation meetings and facilitate meetings as needed.
Assist with maintaining the department Document Management System, including code entry, QA processes, and report releases.
Improve processes, tools, and measures to standardize and improve implementation performance and demonstrate quantifiable value to business units.
Lead the work group and facilitate identification and resolution of local implementation issues.
Complete other duties as assigned.