The Vendor Medical Coding Analyst is responsible for guiding the overall efficiency and accuracy of the vendor payment process by analyzing medical records and supplemental data to ensure diagnostic and procedural codes accurately reflect and support the visit in accordance with correct coding guidelines and medical necessity. The role also leads root cause identification for claims issues and partners with vendor and internal CareSource teams to implement process improvements.
Key responsibilities include auditing medical procedures and terminology, conducting vendor medical record audits, assessing and generating reports to determine claim impact, collaborating with leadership to resolve issues based on industry-standard coding practices, serving as a subject matter expert on reimbursement decisions, developing claims test cases and test plans, monitoring adherence to protocols, building cross-functional relationships, maintaining awareness of federal and state regulatory requirements, and representing CareSource professionally in vendor interactions.
Bachelor's degree required, or equivalent relevant work experience in lieu of the degree. Three years of medical billing/coding experience required. Three years of claims payment experience required. Managed care experience preferred.
Knowledge and skills required include diagnosis codes, CPT coding guidelines, medical terminology, anatomy and physiology, and Medicare/Medicaid/commercial reimbursement guidelines. Intermediate proficiency with Facets, Microsoft Word, Excel, PowerPoint, and Access is required. Strong communication, data analysis, quality assurance, reporting, critical thinking, problem-solving, technical writing, and time management skills are also needed. Certified Medical Coder credentials (CPC, RHIT, or RHIA) are required.
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$54,500 - $87,300
Remote work allowed
Yes
Posted
1 month ago