Provides support to Clinical Policy to ensure accurate coding of Clinical Coverage Guidelines (CCGs) and Claims Edit Guidelines (CEGs), while maintaining authorization management tools.
Works cross-functionally with Health Services, Medical Management, claims operations, and other departments to support clinical policy, authorization rules, payment policy changes, and utilization management strategy. Conducts research on coding rules, state and federal regulations, and evidence-based criteria to support clinical decision-making.
Supports review and response to complex medical coding and payment policy inquiries, assists with escalated disputes, and helps ensure coding decisions are accurate, defensible, and aligned with regulatory and internal standards. Participates in policy committee work, vendor coordination, market communications, and system implementation activities.
Required education:
- Associate's degree in a related field, or equivalent experience
Required experience:
- 4+ years of experience in the medical coding field with a facility, provider, or payer organization
Required knowledge:
- Medicare and Medicaid
- CMS risk adjustment guidelines
- ICD code impact on the CMS HCC risk adjustment model
Required certifications/license, one of the following:
- RHIA
- RHIT
- CCS
- CCS-P
- CPC or CPC-H
Competitive pay
- Health insurance
- 401(k) and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible remote, hybrid, field, or office work schedules
- Additional incentives may be available based on eligibility
Location
Indiana, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$70,100 - $126,200
Remote work allowed
Yes
Posted
1 week ago