Healthcare Coding Analyst Consultant

posted on July 16, 2018

Job Description

Location: St. Paul, MN

Duration: 5 Months

Position Description:

  • 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.

Education:

  • High school or equivalent.
  • Current and valid certification as a professional coder from an accredited institution.

Required Experience:

  • Three years of experience as a certified coder in a healthcare delivery setting, health insurance (payer) setting or Medicare and/or Medicaid setting.

Preferred Experience:

  • Microsoft Word, Excel and PowerPoint skills.
  • Optum Claims Editing Software (CES) – professional and facility.
  • MACESS
  • Amisys