Claims Coding Coordinator

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full.  Below, you’ll find other important information about this position. 

Come join Peak Health to help design and build a health plan from the ground up as our Medical Coding Coordinator for the claims department. Reporting to the Claims Manager, the Medical Coding Coordinator will be an integral member of the health plan’s claims processing team.
The Medical Coding Coordinator is a collaborative member of the Claims Processing operational team. The incumbent will be an excellent communicator who has high acumen in medical claims coding and diagnostics pairing. This role will be relied on for claims coding review for accuracy in both commercial and Medicare Advantage lines of business.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent.

2. Certified Coding Specialist (CCS), Certified Professional Coder-Apprentice (CPC-A) or Certificated Professional Coder (CPC) certification.

EXPERIENCE:

1. One (1) year of health insurance claims related experience.

2. Three (3) years of healthcare related experience.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Three years of monitoring, evaluating audit progress, reporting and work prioritization within cross functional teams.

2. Advanced acumen of ICD 10 and diagnostics coding

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Conducts ongoing data analysis from medical record reviews to identify opportunities to improve provider documentation and coding for members regarding assignment of ICD-10CM codes to chronic conditions. 

2. Participate in regulatory audit training from regulatory agencies such as AHIMA as well as other agencies to ensure that current processes are aligned with best practice.

3. Responsible for quality assurance reviews that require coding input.  Ensure that coding is complaint with CMS coding guidelines and other enterprise coding guidelines for claims processing.

4. Participate and lead any type of regulatory claims audits, internal and external, regarding claims processing and payment.

5. Process both commercial and Medicare claims to adjudication accurately.

6. Manage, review, and maintain CES claims edits in the Optum edit system.

7. Create and maintain edit reporting documents, tracking issues and errors for correction.

8. Maintain and create accurate, detailed, researched documentation on edit maintenance in accordance with CMS guidelines.

9. Meets or exceeds all production and quality standards, maintaining work queues according to department standards.

9. Other duties as assigned by management.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Sitting and working on a computer for several hours a day.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

SKILLS AND ABILITIES:

1. Excellent written and oral communication with internal and external partners.

2. Independent document assessment and excellent time management skills.

3. High Attention to detail and organizational skills.

4. Proficiency in Epic Tapestry software.

5. Proficiency with Microsoft Office Suite and associated applications.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Day (United States of America)

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

PHH Peak Health Holdings

Cost Center:

2902 PHH Claims Operations