Job Summary :
The Coding Analyst II develops, documents, and maintains code level benefit definitions at the Enterprise level for a multi-state and multi-market organization.
Essential Functions :
- Utilize correct coding guidelines to research and interpret complex regulations while collaborating with policy and markets to ensure compliance and resolve conflicts
i.e. Integrate Essential Health Benefits, Prior Authorization requirements, State Provider agreements, CMS requirements, state-specific regulations, Mental Health Parity, etc.
Create, maintain, review, and analyze configuration templates to validate benefit requirements and regulations are accuratePerform peer review of configuration templates and provide documentation of results within the defined Service Level Agreements (SLA) guidelines; identify opportunities for process improvementCommunicate effectively with various internal departments to enhance cross-functional awareness, promote process improvement, and identify root cause resolution of issuesParticipate in the annual benefit change process with Product Management and Benefit Analysts as appropriate per marketUtilize reports to analyze data to assist with issue resolutionResearch and identify industry standard coding practices to stay current and communicate to the BC&S teamAdhere to defined SLAs while also accommodating urgent requestsParticipate in the review and updates of the SOPsUpdate and maintain the data management toolAttend and support internal / external meetingsParticipate in projects as assignedAssist in the training of new hires and continuous training of department peersBack up to all Coding Analyst functionsPerform any other job-related functions as requestedEducation and Experience :
Bachelor's degree in a related field or equivalent years of relevant work experience is requiredMinimum of two (2) years of medical coding or medical billing experience requiredManaged Care experience is required, preferably associated with benefits coding, claims processing, and / or benefit configurationCompetencies, Knowledge and Skills :
Intermediate computer skills with Microsoft SuiteProven understanding of database relationships preferredExtensive knowledge of i CPT, HCPCS and ICD-CM CodesWorking knowledge of other claims related reference data, such as types of bill, revenue codes, places of serviceCritical listening and thinking skillsProven understanding of the upstream and downstream impacts of code level benefit detailsProblem solving skillsCommunication skills both written and verbalAbility to work independently and within a team environmentAttention to detailKnowledge of Medicare, Medicaid or Marketplace insurance benefits preferredClaims processing knowledge preferredAbility to work in a fast-paced environment managing multiple prioritiesAbility to build and maintain strong working relationships with cross-functional teamsStrong interpersonal skills and high level of professionalismFacets or other systems knowledge / training preferredKnowledge of regulatory requirements of Outpatient Prospective Payment System (OPPS) and other payer requirements, preferredExcellent organizational skills, and ability to meet deadlinesLicensure and Certification :
Certified Medical Coder (CPC, RHIT or RHIA) is requiredWorking Conditions :
General office environment; may be required to sit or stand for extended periods of timeCompensation Range :
$61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type : Salary
Competencies :
Create an Inclusive EnvironmentCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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