CARR Analyst II
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Job Description
Coding Analyst II supporting facility coding, reimbursement, and claims accuracy for BlueCross BlueShield of Tennessee. Researching payment methodologies, policies, edits, and regulatory changes.
Responsibilities:
- Research, design, analyze, recommend, implement, resolve problems, maintain, and coordinate coding and reimbursement activities
- Research and prepare coding and reimbursement policies, procedures, and billing guidelines
- Coordinate data collection and administrative functions for coding, reimbursement, and billing changes
- Advise on coding, reimbursement, and billing issues through corporate committees and workgroups
- Assist in developing educational materials for staff training
- Provide coding consultations for company administrative functions and reviews
- Review, prioritize, prepare, and present recommended code-editing changes
- Support facility coding and reimbursement across contract development, system configuration, code maintenance, medical policy implementation, claim editing, provider disputes, appeals, coding updates, and claims adjudication
- Research complex coding and reimbursement issues and evaluate regulatory and industry changes
- Collaborate with Claims, Provider Network Management, Medical Policy, Clinical Coding Review, IT, and Customer Service to support payment accuracy, compliance, and reimbursement solutions
Requirements:
- Experience in facility coding and reimbursement, including inpatient and outpatient payment methodologies
- Experience with claims processing, reimbursement research, regulatory guidance, claims editing, and payment integrity reviews
- Strong analytical and problem-solving skills with ability to research and communicate complex reimbursement topics
- Knowledge of MS-DRGs, APCs, revenue codes, facility billing requirements, contract reimbursement methodologies, and payer reimbursement systems strongly preferred
- No sponsorship available
- Bachelor's Degree or equivalent work experience required; equivalent experience is defined as 4 years of professional work experience in a corporate environment
- 3 years of experience with Medical/Clinical Coding
- Coding certification from a nationally recognized coding organization required, such as AAPC CPC/CPC-H or AHIMA CCS-P/CCS; if not certified, must obtain certification within two years of hire
- Ability to work independently with minimal supervision or in a team environment
- Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint)
- Ability to handle multiple projects
- Excellent oral and written communication skills
- Strong interpersonal and organizational skills
- Knowledge of claims, customer service, member benefits, authorization, reimbursement applications, and configuration
- Knowledge of BlueCross BlueShield of Tennessee and Medicare provider reimbursement methodologies in at least one specialty area: Professional, Facility, or Home Health services
- Basic knowledge of HIPAA-standardized claims transactions and medical/clinical coding
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