Coding Specialist Jobs

About The Position

Requirements

• The ability to learn and adhere to health plan and regulatory compliance requirements for UM.
• Excellent communication skills, both verbal and written.
• Knowledge and expertise in using Outlook email for email and scheduling.
• Data entry and computer skills in keyboard typing and navigating systems.
• Excellent organizational skills.
• Demonstrated decision-making skills.
• Initiative-taking with ability to work under direction, is flexible to change has excellent follow-through.
• Strong and proven skills in meeting quality and productivity measures.
• Strong attendance in past positions.
• Accurate use of medical terminology and codes (ICD-10, HCPC and CPT®).
• Clear and concise writing skills in accordance with healthcare documentation standards.

Nice To Haves

• Minimum 1-3 years of experience in healthcare preferred.
• Utilization Management experience preferred.
• Microsoft Excel experience preferred.
• Familiarity with the current Referral Management System (RMS)
• Customer Service skills preferred.
• Familiarity with medical terminology and experience with ICD-10, HCPC and CPT codes.
• Medical Assistant Certification and/or 1-3 years’ experience.
• Certified Nursing Assist (CNA)
• Certified Coding Associate (CCA)
• Certified Coding Specialist (CCS)

Responsibilities

• Rotating duties in the following areas Enter incoming verbal, mail, and eFax (FAX COMM) requests for service using correct types and codes.
• Complete the authorization intake checklist.
• Complete authorization requests in accordance with the operational procedures outlined within the HRM Operations Manual and the Policy Provisions.
• Research and troubleshoot complex authorization rules to render the correct decision based on members benefits, a Health Plan’s contractual arrangements, and specific instructions on if a service may be authorized.
• Answer phone queue line calls in accordance with departmental standards.
• Monitor UM related Customer Service Requests (CSR) actively and respond appropriately within department standards.
• Serve as a resource to customer service.
• Overall support of the Utilization Management team (both the clinical and non-clinical) through interactions with providers, facilities and/or members.
• Maintain a current knowledge base of Utilization Management process and timelines.
• Use and document all notes pertaining to the UM function in the current Referral Management System (RMS).
• Conducts outreach calls to provider offices, collecting relevant information according to script tools, and protocols.
• Conducts member notification calls on urgent authorization requests.
• Maintain productivity and performance expectations as identified by the unit supervisor/or designee.
• Conduct calls in a courteous and customer service friendly manner.
• Creates, updates maintains and/or closes authorizations or tasks for services as assigned within client process guidelines and routes case to the appropriate associates based on established guidelines.
• Processes all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines.
• Refers to the appropriate clinical team members for review as defined by workflow.
• Clerical responsibilities such as processing urgent calls, mailing notifications, and document retrieval.
• Complete Notifications for services not a covered benefit per operational guidelines.
• Demonstrates a professional and courteous manner when communicating with others with the ability to state clearly and accurately the agreed upon resolution.
• Performs additional duties as assigned.