Location: Tampa, FL
- Collects and analyzes data to evaluate operational obstacles which include revenue and compliance issues and makes recommendations to resolve issues in a timely matter.
- Uses the medical classification system to design the benefit packages with proper ICD-9, CPT-4, HCPCS for configuration into the Peradigm System.
- Disseminates benefit determinations to key stakeholders administering benefits (health services, configurations, etc.) throughout the organization.
- Serves as an integral role in the testing, analysis, and benefit configuration of new and existing plans.
- Reviews, analyzes and translates diagnostic procedural phrases into coded form.
- Updates and maintains adjudication system with defined code sets in logical order.
- Coordinates with internal operations departments to ensure data accuracy.
- Produces reports from the Peradigm System to analyze necessary modifications to codes sets, BRULES and MEDEFs.
- Creates testing scripts for new and existing plans.
- Assists in the on-going evaluation of the benefit configurations within the Peradigm System for new and existing benefit plans.
- Documents the configuration of new plans as well as changes in existing plans.
- Provides feedback to stakeholders regarding feasibility and requirements for enhancements to benefit configuration.
- Provides research assistance for the resolutions of benefit issues.
- Serves as a liaison of benefit configuration to external departments.
- Collects and analyzes data to evaluate operational difficulties and makes recommendations to solve problems.
- Performs special projects as needed.
- Required An Associate’s Degree in CIS, BIS, or coding
- Required or equivalent work experience
- Required 2 years of experience in medical coding and configuration
- Intermediate Other Applies coding knowledge to ascertain codes sets for each service
- Intermediate Other Ability to break procedures down at a granular level and organize data in a logical manner
- Intermediate Other Ability to conduct Internet research to update code sets
Licenses and Certifications:
- Preferred RMC certification
- Required Intermediate Peradigm (Diamond)
- Preferred Intermediate Microsoft Access
- Preferred Intermediate SQL Server System
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Outlook
- Preferred Intermediate Other Knowledge of organization of data within medical adjudication systems