Job description
Manages claims coding rule process. Evaluates claims coding rule change request from clinical, financial, and claims operations perspectives. Provides regulatory and correct coding research on change requests and makes recommendations on correct payment policy and edit functionality. Defines requirements and partners with vendors throughout testing and implementation. Supports provider dispute/appeal team.
Associate degree preferred, but a combination of education and experience will be considered.
Knowledge of CMS/State laws and AMA guidance.
Advanced user and knowledge of claims payment system.
Knowledge of 3M Encoder
Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations.
Billing expertise in UB92, 1500 and other healthcare services.
Knowledge of one or more of the following: SQL, Xcelys, CES, iHT
Demonstrated written communication skills.
Demonstrated leadership skills.
Demonstrated interpersonal/verbal communication skills.
Ability to work as part of a team.
Demonstrated problem solving skills.
- Manages research of claims coding rule initiatives including the development of detail work plans.
- Receives and logs requests of changes for tracking purposes.
- Maintains a library of all the existing and retired rules, the source of the rule and the implementation/retire date of the rule (by Group/Plan/Division).
- Documents supporting authority for each claim coding rules by Group/Plan/Division (Master Grid).
- Participates in cross-functional teams to address key claims coding rule issues facing the organization.
- Administers communication to Network and collects feedback.
- Evaluates change proposal from a regulatory perspective, financial perspective, and claims operational perspectives.
- Seeks professional feedback from Health Services, Finance, and Claims on claims coding rule changes.
- Identifies coding error (e.g., upcoding, bundling/unbundling) and recommends correct coding of behavioral health claims.
- Research state laws and CPT/AMA guidance.
- Presents change proposals.
- Communicates effectively to network.
- Develops relationship with claims coding rule software vendors.
- Receives, researches, and determines appropriate action steps for escalated provider disputes from Dispute/Appeal team, Claims, and Network.
- Support Claims, Configuration, and/or Dispute/Appeal teams as necessary.
- Manages high visibility projects and provides recommendations and status to Leadership.
- Acts as the first point of contact in dealing with day to day business issues and support for problem resolution.
- Researches, analyzes, and presents savings opportunities to Leadership
- Perform other duties as assigned.
Other Job Requirements
Responsibilities
5+ years of experience in the medical coding field with a facility, provider, or payer organization.
Associate degree preferred, but a combination of education and experience will be considered.
Knowledge of CMS/State laws and AMA guidance.
Advanced user and knowledge of claims payment system.
Knowledge of 3M Encoder
Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations.
Billing expertise in UB92, 1500 and other healthcare services.
Knowledge of one or more of the following: SQL, Xcelys, CES, iHT
Demonstrated written communication skills.
Demonstrated leadership skills.
Demonstrated interpersonal/verbal communication skills.
Ability to work as part of a team.
Demonstrated problem solving skills.
General Job Information
Title
Senior Coding Research Analyst
Grade
24
Work Experience - Required
Claims
Work Experience - Preferred
Education - Required
A Combination of Education and Work Experience May Be Considered., GED, High School
Education - Preferred
Associates
License and Certifications - Required
CCS - Certified Coding Specialist - Enterprise
License and Certifications - Preferred
Salary Range
Salary Minimum:
$58,440
Salary Maximum:
$93,500
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
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