Location: Phoenix, AZ
Duration: 6 Months
- This position is responsible to identify and analyze changes to CPT, CPCS, ICD-10-PCS, ICD-10-CM codes and proprietary laboratory codes and to facilitate the timely implementation of same across all business systems.
- Collaborate with staff to enhance operational effectiveness and efficiency by identifying opportunities for automation of existing manual claims processes.
- Research and resolution of complex clams and reimbursement issues.
- Accurately elicit, analyze, research and write business requirements and provide recommendations of claim edits for Commercial and Medicare lines of business.
- Collaborate with client and vendor to address upgrades and updates to Claims Editing System (CES) and any related hardware and/or software updates and upgrades.
- Collaborate with Project Managers to implement larger scale updates to software applications and complex claims editing.
- Participate in activities related to the testing of core systems, database impacts and interfaces to meet the business requirements.
- Serve as a Subject Matter Expert on CES, code editing and claims editing focusing on Commercial and Medicare lines of business.
- Identify and analyze coding changes as they relate to accurate claims processing.
- Collaborate with vendor and client resources to ensure successful implementations of edit rules and regulatory updates as it pertains to Commercial and Medicare lines of business.
- Identify, research and resolve inaccuracies and inconsistencies in the system as they impact claims payment and adjudication and other upstream and downstream transactions and processes.
- Conduct audits of system updates and edit configuration in production to confirm system function and CES editing matches requirements.
- Collaborate with key internal departments to manage and resolve complex claim issues, maximize operational effectiveness and support claim automation.
- Other projects and duties as assigned.
- Three years of experience as a certified coder in a healthcare delivery setting, health insurance (payer) setting.
- Experience and knowledge of Commercial and Medicare lines of business.
- Experience with claims editing utilizing the CES application.
- Bachelor’s degree or equivalent.
- Expertise in the implementation, support and troubleshooting of applications software.
- Experience with configuration of business rules in a healthcare claims processing application.
- Microsoft Word, Excel and PowerPoint skills.
- Optum Claims Editing Software (CES) – professional and facility.
- High school or equivalent.
- Current and valid certification as a professional coder from an accredited institution.