Our client, a large, complex healthcare organization in Indianapolis, seeks high-performing and successful Senior coder within their insurance group of the healthcare organization. A successful candidate must have experience in all areas of outpatient/hospital coding and working knowledge of ICD-9/10-CM; CPT; DRG, APC, with expertise in ICD-9/10-CM coding principles and reimbursement implications as well as modifier rules required.

Responsibilities include but not limited to:

Manages and coordinates the application of medical claims billing codes. Identifies and monitors accurate coding practices based on CMS, state and federal guidelines. Monitors authorization and service category for coding changes and accuracy. Monitors authorization approval rates and claims auto adjudication. Owns and oversees the review of accurate codes submitted on medical claims including; ICD-10, CPT, HCPCS. Coordinates with BSG on configuration. Organizes implementation of new codes. Collaborates with internal departments and external vendors to ensure the appropriate usage of codes, conducts high dollar, coverage determinations and reimbursement claims audits. Owns clinical editing appeals resolution and system(s) assessment of annual code and compliance updates. Communicates with internal and external customers regarding coding deficiencies and updates to achieve accurate claims adjudication based on compliant use and submission of valid medical billing codes.

Qualifications:

• Requires a minimum of 3 years of experience.
• Certified Medical Coder required (CMC).
• Bachelor’s Degree preferred.
• Health Plan and Claims knowledge required.
• R.H.I.T., C.C.S., C.C.S-P, CPC-P; or CPC-H. is required.
• Knowledge of NCQA, CMS, ACA IDOI &AAPC coding guidelines required.
• Experience in trending coding patterns and conducting regular monitoring and assessment of coding assignment decisions to ensure appropriateness of reimbursement required.
• Working knowledge of overseeing complex audits and ability to troubleshoot, using electronic medical records, audit issues with providers and internal departments required.
• Working knowledge of governmental annual code updates and determinations required.