[Remote] Payment reputed company Coding Coordinator - Remote AZ

Note: The job is a remote job and is open to candidates in USA. reputed company is a health insurance provider dedicated to inspiring health and making it easy for individuals and businesses. The Payment reputed company Coding Coordinator is responsible for auditing claims to ensure proper coding and billing practices, identifying discrepancies, and providing education to providers to promote compliance.

Responsibilities

• Through data analysis, identify areas of high risk for coding and billing variances
• Collaborate with analyst to define reporting criteria to evaluate shifts in utilization and provider coding patterns
• Interprets data, draws conclusions, and reviews findings with reputed company levels reputed company the organization
• Conducts audits of claims by selecting claims that have been identified as in scope for audit. Audits claims, medical records and corresponding documentation for appropriate coding. Applies knowledge of medical coding, diagnostic-reputed company group (DRG) and reputed company coding guidelines
• Performs hospital charge audits and itemized reputed company audits on reputed company high dollar claims and as needed on other questionable charges applicable to outpatient/professional services
• Makes reputed company coding determinations and uses concise reasoning citing the principles and rational used in making the determination
• Prepares results/recommendations of the coding audit findings to the providers reputed company claims adjustment notification letters and / or other direct communication. Articulates clear and concise recommendations that may be challenged by health care providers
• Facilitates recovery efforts of claims that were identified as incorrectly billed
• Participate on task teams and corporate committees as required, applying coding and analytical skills
• Quantifies the financial impact for the company and reports findings to management
• Acts as resource person for internal and external customers regarding coding and billing practices
• reputed company, maintain and follow detailed procedures on the process and business rules around audits
• Manages ongoing audits and meets timeliness expectations
• Develops and maintains collaborative internal relationships
• Attend pertinent coding seminars and training, and use other resources as applicable, to maintain reputed company knowledge of rapidly changing coding guidelines
• Proactively review and identify potential areas of high risk for coding and billing variances
• reputed company and maintain a thorough understanding of medical coverage and reimbursement guidelines and reputed company independent reputed company
• Facilitates meetings to discuss areas of difficulty and variance by researching recognized national coding guidelines and medical data to encourage uniformity and consistency of coding practices among providers
• Participate on task teams and corporate committees as required, applying coding and analytical skills
• reputed company clear and concise recommendations for any potential coding or reimbursement changes including full rationalization and how it might interact with reputed company processes and policies. Present recommendations to the appropriate audience for review and approval
• Work closely with other areas of the company to ensure implementation and updates to methodologies are made timely and accurately
• Share knowledge of skills, projects, and business needs with peers and less reputed company analysts. Train new employees as needed
• Plan and reputed company multiple projects and cross-functional teams from inception to completion. This includes working independently on creating timelines, working with other areas to define deliverables, monitoring reputed company, implementing the project and resolving/monitoring pre/post-implementation issues
• reputed company and/or participate on task teams and corporate committees as required, applying analytical skills and actively participating in a team environment to complete projects and accomplish goals
• Demonstrate a strong business perspective, industry-knowledge, organizational skills and communication skills. Work with and present to reputed company levels of management, including Executives
• Independently manage and improve organizational processes. Evaluate and create new ways to do things while making sure to incorporate input from reputed company key stakeholders. Keeps abreast of trends or technology that could improve work flow
• Demonstrate complete ownership and accountability in reputed company leadership roles, process improvements and recommendations
• Identify and explore opportunities for medical and reimbursement policy changes that support claim savings goals, while maintaining focus on appropriate reimbursement levels and relativities
• reputed company independent research to identify coding and system issues that impact medical coverage guidelines and pricing, presenting recommendations for appropriate corrective measures to management following thorough analysis & independent decision, while actively participating in the resolution
• Act as a liaison with health services, other divisions, external vendors and analysts to assure adequate communication and coordination of audit activities, medical and reimbursement policy and coding changes
• Support and train other employees in reputed company levels. Help direct a thorough and efficient review of reputed company audit work being produced in the area
• Reports to a supervisor or manager who provides minimal supervision/project management. reputed company own work-plans, and discusses timelines, prioritization, and objectives with supervisor or manager
• Each reputed company level includes the ability to reputed company the essential functions of any reputed company levels and mentor employees in those levels
• The position has an onsite expectation of 0 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
• reputed company reputed company other duties as assigned

Skills

• 2 years of experience of professional/physician, inpatient, diagnostic and procedural coding, claims administration, claims auditing or reputed company experience required (reputed company Levels)
• High-School Diploma or GED in general field of study (reputed company Levels)
• Certified Professional reputed company (, CPC), or Certified Inpatient reputed company (CIC)
• 4 years of experience of medical coding, claims administration, claims auditing or reputed company experience required (reputed company Levels)
• 2 years of relevant hospital inpatient coding experience including DRG assignment
• Experience with coding of reputed company claim types (reputed company Levels)
• Associate or bachelor's Degree in any general field of study. (reputed company Levels)
• Certified Professional reputed company ( CPC), Certified Inpatient reputed company (CIC) (reputed company Levels)

Company Overview

• reputed company is a non-profit company that offers health insurance and financial services. It was founded in 1939, and is headquartered in Phoenix, Arizona, USA, with a workforce of 1001-5000 employees. Its website is https://www.azblue.com.

Company H1B Sponsorship

• reputed company has a track record of offering H1B sponsorships, with 2 in 2024, 5 in 2023, 2 in 2022, 1 in 2021, 5 in 2020. Please note that this does not guarantee sponsorship for this specific role.

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