Job Description:
***Only W2 resumes are accepted
Work Location: Fully Remote Candidate Location: Candidate MUST be a SC resident. No relocation allowed.
This project is an immediate support need that will primarily focus on providing consulting services to operations and policy staff for the current medical coding federal requirements, quarterly and intermittently, and all coding changes associated with agency initiatives to ensure compliance policy and code change alignment. Note - Medicaid Management Information System (MMIS) is the system of record.
The current position s focus and priority is the continued support of serving as a subject matter expert (SME), utilizing knowledge of medical coding and MMIS to support change requests while ensuring change requests and system updates result in the expected claims adjudication outcomes for the benefit of Medicaid members and providers.
DAILY DUTIES / RESPONSIBILITIES:
The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance.
Specific duties include, but are not limited to:
- Collaborates with internal recipient and owner of initial review of codes to determine scope of changes for planning and timely completion.
- Receives listings of codes changes distributed to the Reference Administration and Medicaid Program staff for review and analysis.
- Serves as an approver within the code change / update process following the internal initiation of annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
- Serves as lead for meetings with Agency personnel, stakeholders, and process owners.
- Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
- Researches business rules, requirements, and models to complete initial analysis and recommendations.
- Maintains business rules, requirements, and models in a repository.
- Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
- Participates in agency projects and related initiatives requiring subject matter expertise.
- Other duties, as assigned or required.
Required Skills:
- Bachelor s degree in Health Information, Healthcare Administration, or related field; equivalent experience may be considered with a minimum of 3+ years of direct supervisor experience.
- 5+ years experience in healthcare insurance; medical review, program integrity, or appeals.
- 5+ years experience working with IT developers/programmers in a payor environment.
- 5+ years' experience Medical Coding in payer environment.
- 3+ years' clinical experience in a healthcare environment (Strong clinical assessment and critical thinking skills.)
- 5+ years' strong knowledge of ICD/CPT/HCPCS translation and coding methodologies.
Preferred Skills:
- 5+ years' experience in policy remediation.
- 5+ years' Medical Claim processing systems experience.
- Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and / or other medical coding software programs).
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