Location: St. Paul, MN
Duration: 5 Months
- This position is responsible to identify and analyze changes (additions, deletions, modifications) to CPT, HCPCS, ICD-10-PCS, ICD-10-CM codes and proprietary laboratory codes and to facilitate the timely implementation of same across all appropriate departments and business systems.
- Collaborate with Configuration staff to enhance operational effectiveness and efficiency by identifying opportunities for automation of existing manual claims processes.
- Research coding queue service forms to resolve edit flags and ensure appropriate adjudication of claims.
- Serve as a subject matter expert and provide information and education on coding and coding-related issues.
- Facilitate the development of education materials for key areas and identify training opportunities for internal and external customers.
- Research and resolution of complex claim and reimbursement issues.
- Participate in the process for implementation of quarterly, annual and bi-annual updates to CPT, HCPCS, ICD-10-PCS, ICD-10-CM and proprietary laboratory codes
- Identify and analyze coding changes as they relate to accurate claims processing.
- Minimize rework by ensuring stakeholders are aware of and understand changes and impact on individual lines of business.
- Process service forms in coding queues accurately and consistently to maintain expected SLA’s.
- Serve as a primary resource for coding issues related to claims adjudication.
- Develop and maintain education/training materials for key internal business areas related to coding and reimbursement issues.
- Identify how coding changes will impact specific departments or areas.
- Provide face-to-face education and training as needed
- Assist in the development of training and education materials for providers.
- Present focused education for providers as needed to minimize claim denials and unnecessary rework.
- Represent the client at external professional committees such as Administrative Uniformity Committee Medical Code Technical Advisory Group.
- Proactively distribute information as appropriate across departments.
- Participate in and represent coding in internal work groups and committees.
- Collaborate with key internal departments to manage and resolve complex claim issues, maximize operational effectiveness, support automation and reduce duplication of effort and re-work.
- Collaborate with Claims Training staff to ensure work instructions impacted by coding changes are identified and updated in a timely manner
- Assist in the management of the Coding Request Board to resolve coding questions and to complete coding-specific projects
- Other projects and duties as assigned.
- High school or equivalent.
- Current and valid certification as a professional coder from an accredited institution.
- Three years of experience as a certified coder in a healthcare delivery setting, health insurance (payer) setting or Medicare and/or Medicaid setting.
- Microsoft Word, Excel and PowerPoint skills.
- Optum Claims Editing Software (CES) – professional and facility.