Medical Coding Consultant-Risk Optimization

Baton Rouge, LA 70801

Posted: 08/30/2018 Employment Type: Temporary Industry: Clerical Job Number: 00004MWY Pay Rate: 0.00
Spherion is looking for a Medical Coding Consultant-Risk Optimization for a large insurance company in Baton Rouge, LA.

This position is looking for someone who has experience working with Large projects, can be responsible for overseeing production and giving guidance to team members. MUST have STRONG Hedis and Coding experience... Ideal candidate that has come from competitor and has experience with large groups is preferred.

This position serves as Risk Optimization's chief medical coding expert on CPT, HCPCS, ICD-10-CM, and CDT coding for internal and external customer service requests, reviewing and validation of medical documentation to determine accuracy, coding updates, education, and expert analysis of coding statistics to determine focus areas for targeted medical review activities.

Accountable for complying with all laws and regulations associated with duties and responsibilities.

Registered Nurse or a Bachelor's degree in Health Information Management or related fields is required. 4 years of related experience can be used in lieu of the bachelor's degree.

A minimum of 5 years current hands-on clinical or consultant-level experience with in-depth research, analysis and application of CPT, HCPCS, and ICD-10-CM coding, billing and reimbursement guidelines for Medicare or private payers is required. Medical coding experience in a clinical setting is preferred.

Certified professional coding credentials for CPT, HCPCS, and ICD-10-CM medical coding systems is required.

Strong body of knowledge regarding disease processes and medical and surgical procedures is required. Knowledge and understanding of medical terminology is required. Experience in medical record auditing / review is preferred.

Extensive experience with provider billing practices, American Medical Association coding guidelines, Correct Coding Initiative edits, Physician Specialty guidelines, payor reimbursement programs, claims adjudication processes, and regulatory agency policies (CMS/HCFA) is required.

Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) is preferred

Proficiency with Microsoft Excel is required.

Conducts coding validation reviews and coordinates adjustments for Risk Optimization methodology. Provides written medical coding expert-level responses to internal and external customer requests and third party vendors for clarification of medical coding issues, clinical editor bundling and filtering, medical coding policy, regulatory agency policy and coding-related reimbursement and medical policy issues, in a prompt and efficient manner to support medical coding-related activities at BCBSLA.

Provides expert testimony on behalf of BCBSLA for medical coding-related issues and serves as the chief medical coding resource for the Risk Optimization Director, Medical Coding Committee, Medical Policy Implementation Committee, Financial Investigations, Provider Reimbursement, Provider Audit, Provider Relations, Network Development, I.T., Medical Management, Actuarial and Medical Coding in a prompt and efficient manner to support medical coding related activities at BCBSLA.

Develops and coordinates development of customized code lists, including code updates and crosswalks for BCBSLA mainframe system edits, CMS Edge Server edits, clinical editor customizations, CMS policy implementations, reimbursement program development, medical coding audits, departmental research and projects in a prompt and efficient manner to support medical coding-related activities at BCBSLA.

Makes formal and informal presentations on medical coding issues to internal and external customers of BCBSLA to provide continuing education and to clarify medical coding-related processes at BCBSLA.

Serves as the Risk Optimization representative in the ICD-10 implementation.


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