Our Healthcare Insurance client is seeking a Sr. Medical Coding Analyst to join their team for a contract role!
Our client has more than 5,000 employees and is the number 1 health insurer in the state of North Carolina serving more than 3.89 million customers.
Health care is changing, and our client is leading the way by provide innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs. Our client is a not-for-profit with headquarters in Durham, NC.
Position: Sr. Medical Coding Analyst
Location: remote within NC
Term: 6 months
Day-to-Day Responsibilities: Provides technical, clinical and coding expertise to support coding related projects. Consults/collaborates with all plan areas regarding national coding standards and applicability to claims processing systems and reimbursement policy. Presents findings and trends in coding practices to internal/external audiences and makes recommendations regarding coding standards.
- Provide consultative expertise to other areas (e.g. Compliance, Legal, Network Management and Medical Policy) regarding current and emerging coding/documentation issues.
- Develop policies and standard operating procedures for medical review area as applicable to ensure compliance with regulatory agencies, state and federal law and ensure consistency of reviews.
- Identify trends in coding practices to internal/external audiences and make recommendations regarding coding standards.
- Assimilate necessary documentation, including medical records, and apply clinical coding expertise to evaluate appropriateness of provider coding and assess medical necessity of services rendered with referral to Medical Director as appropriate.
- Gather appropriate claims data, analyze and prepare summary of analysis to assist in the development of resource allocation strategies to meet changing business needs.
- Respond to provider letters of inquiry regarding specific medical procedure coding issues and provide education on proper coding techniques via written and/or telephonic communications.
- Develop education materials for providers identified as outliers and collaborate with Network Management on delivery/communication of information to provider.
- Maintain documents for tracking audit results, status/outcomes of reviews etc.
- Participate in or lead special projects based on business area needs requiring independent, sound decision making and broad based understanding of impact on the individual department as well as impact on corporate objectives.
Is this a good fit? (Requirements):
- Registered Nurse with valid NC license
- 5 years clinical experience. 3 of these years must include medical coding experience.
- Licensed Practical Nurse with valid NC license
- 7 years clinical experience. 3 of these years must include coding experience.
**Required: Certified Professional Coder*