Medical Coding – Vendor and Claims Edit Specialist
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Job Description
Medical Coding Specialist at Geisinger Health Plan working with coding standards and partnerships. Leading internal committees and mentoring staff while ensuring compliance in claims processing.
Responsibilities:
- Acts as a leader, liaison, and resource working collaboratively with a diverse group
- Applies expanded knowledge of CPT, ICD-10 and HCPCS coding skills toward the maintenance and development of prospective claim edits and partnerships
- Determines payment compliance with clinical and reimbursement policies
- Researches CPT codes to clarify coding issues, as required
- Determines opportunities with current vendor partnerships and implementations, exploring new opportunities as well
- Coordinates, reviews, and recommends changes for the yearly opportunity analysis
- Reviews and responds to claim edit appeals and rational requests
- Coordinates, supports, and resolves vendor needs both prospectively and retrospectively
- Problem solves system/claim edit issues that may come up
- Tests and verifies new claim edits as a component of maintenance and during implementation for new vendors
- Leads the Edit Expansion Committee as a component
- Leads routine maintenance and oversight meetings with vendor partners
- Acts as a subject matter expert in support of internal workgroups/committees, etc
- Interacts with providers and/or Account Managers to clarify documentation and billing issues identified
- Leads internal development, testing, maintenance, and expansion of internal claims edits
- Leads the development of the ClaimsXten Policy Management Module
- Mentors less experienced staff and new hires.
Requirements:
- Minimum one certification required: Certified Professional Coder CPC through AAPC
- Certified Professional Biller through AAPC
- High School Diploma or Equivalent (GED)- (Required)
- Graduate from Specialty Training Program- (Preferred)
- Minimum of 5 years-Related work experience (Required)
- Minimum of 5 years-Health Insurance/Managed Care (Preferred)
Benefits:
- healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners
- atmosphere of collaboration, cooperation and collegiality
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