Supports the Facility Coding & Reimbursement Team across all lines of business, including contract development, system configuration, code maintenance, medical policy implementation, claim editing, provider disputes, appeals, coding updates, and claims adjudication.
Researches complex coding and reimbursement issues, evaluates regulatory and industry changes, and collaborates with Claims, Provider Network Management, Medical Policy, Clinical Coding Review, IT, and Customer Service to support payment accuracy, compliance, and reimbursement solutions.
Responsibilities include research, design, analysis, recommendation, implementation, problem resolution, maintenance, and coordination of coding and reimbursement activities. The role also prepares coding and reimbursement policies and procedures, billing guidelines, supports data collection for coding and reimbursement changes, advises corporate committees and workgroups, assists with training material development, and provides coding consultation to support administrative functions and code editing changes.
Bachelor's degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment.
3 years of experience with medical/clinical coding.
Coding certification from a nationally recognized coding organization such as AAPC CPC or CPC-H, or AHIMA CCS-P or CCS, is required. If not currently certified, the candidate must be willing to obtain certification within two years of hire.
Preferred knowledge includes:
- Facility coding and reimbursement
- Inpatient and outpatient payment methodologies
- Claims processing and reimbursement research
- Regulatory guidance, claims editing, and payment integrity reviews
- MS-DRGs, APCs, revenue codes, facility billing requirements, contract reimbursement methodologies, and payer reimbursement systems
- BlueCross BlueShield of Tennessee and Medicare provider reimbursement methodologies
- HIPAA standardized claims transactions and medical/clinical terminology
Additional qualifications:
- Ability to work independently or in a team environment
- Proficiency in Microsoft Office
- Strong analytical, problem-solving, communication, interpersonal, and organizational skills
- Ability to manage multiple projects
- Knowledge of claims, customer service, member benefits, authorization, and reimbursement applications and configuration
Location
Tennessee, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
2 weeks ago