Responsible for identifying and applying coding guidelines established by the American Medical Association (AMA) and payment rules established by the Centers for Medicare & Medicaid Services (CMS) to ensure proper and timely claims processing.
Key responsibilities include tracking quarterly CMS service code changes, updating internal payment rules, reviewing Medicare national coverage determinations (NCDs), responding to operational medical policy referrals and provider relations inquiries, evaluating post-service appeals and payment grievances, and facilitating education for providers and internal teams on correct coding practices.
The role also supports system configuration by requesting implementation of payment rules, coordinating validation with systems teams, testing edits, and identifying issues that could affect claims and provider payments.
Minimum qualifications
- Bachelor's degree in Business Administration with at least 3 years of experience in coding and payment rules, or a related area
- Associate degree or 60–64 approved college credits in Health Information Technology or Coder Technician with at least 4 years of experience in coding and payment rules
- CCS or CCS-P certification preferred
- Previous experience with claims editing and processing systems
- Advanced Spanish and English language skills, both written and verbal
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
2 months ago