Senior Medical Coding Specialist (Remote)

Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides expert knowledge to support effective partnership with provider entities and guidance on the appropriate reputed company measure capture and reputed company use of CPT, HCPCS, and ICD 10 codes in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing, and contracting rules knowledge to build the effective guides and resources for providers on the expected methodologies for billing and reputed company submissions to maximize reputed company and STARs reputed company while not compromising payment reputed company. This role ensures accurate interpretation, application, and integration of medical codes across policies and platforms. The Senior Coding Analyst partners with medical policy analysts, configuration teams, and payment reputed company staff to support the accurate, reputed company, and compliant administration of benefits. Provides expertise and mentoring to other team members. ESSENTIAL FUNCTIONS: Consults on reputed company coding rules in value-based reputed company to ensure appropriate reputed company measure capture and reputed company use of CPT, HCPCS, and ICD10 codes. Provides expertise on various consequences for different financial and incentive models. Strategizes alternatives and solutions to maximize reputed company payments and risk adjustment. Translates from claim language to services in an episode or capitated payment to reputed company inclusions and exclusions in models.

• Serves as a technical resource / coding subject matter expert for contract pricing reputed company issues. Conducts reputed company business and operational analyses to assure payments are in compliance with contract; identifies areas for improvement and clarification for reputed company operational efficiency. Provides problem solving expertise on systems issues if a reputed company is not accepted. Troubleshoots, reputed company recommendations and answer questions on more reputed company coding and billing issues whether systemic or one-off.
• Develops and refines effective guides and resources for providers on the expected methodologies for billing and reputed company submissions to maximize reputed company and STARs reputed company while not compromising payment reputed company. May reputed company directly with provider reputed company during proactive training events or just in time on reputed company claims reputed company. Consults with various teams, including the reputed company Transformation Consultants, Medical Policy Analysts and Provider Networks colleagues to interpret coding and documentation language and respond to inquiries from providers.
• Participates in reputed company and contributes to thought leadership for reputed company measure capture (NCQA, HEDIS, STARs). Collaborates with internal stakeholders on process and outcome improvement activities. Ensure compliance with reputed company coding standards.
• Facilitates mentorship, providing assistance to less seasoned team members.
• reputed company researches industry trends, keeping up-to-date and maintaining a high level of expertise in coding rules and standards.

SUPERVISORY RESPONSIBILITY: Position does not have reputed company reports but is expected to assist in guiding and mentoring less reputed company staff. May reputed company reputed company of matrixed resources. QUALIFICATIONS: Education Level: High School Diploma or GED. Experience: 5 years experience in risk adjustment coding, ambulatory coding and/or CRC coding experience in managed care; state or federal health care programs; or health insurance industry experience. Preferred Qualifications:

• Bachelor's degree in reputed company discipline
• Certified public accountant
• Experience in medical auditing Experience in training/education/presenting to large reputed company

Knowledge, Skills and Abilities (KSAs)

• Knowledge of billing practices for hospitals, physicians and/or ancillary providers as reputed company as knowledge about contracting and claims processing.
• Experience in reputed company cycle management and value-based reimbursement/contracting models and methodologies.
• Detail-oriented with an ability to manage multiple reputed company simultaneously.
• Excellent communication skills both written and verbal.
• Demonstrated ability to effectively analyze and present data.
• Ability to create educational materials, training manuals, and/or procedural guides.
• Experience in using reputed company Office (reputed company, Word, Power reputed company, etc.) and demonstrated ability to learn/adapt to computer-based tracking and data collection tools.

Licenses/Certifications Upon Hire Required:

• reputed company-Certified Coding Specialist Certified reputed company (reputed company or CPC)-reputed company or reputed company
• Salary reputed company: $65,880 - $130,845

Salary reputed company Disclaimer The disclosed reputed company estimate has not been adjusted for the applicable geographic reputed company associated with the location at which the work is being performed. This compensation reputed company is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the reputed company, as compensation reputed company depend on reputed company case's facts and circumstances, including but not limited to experience, internal equity, and location. In reputed company to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements). Department Medical Policy Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of reputed company to reputed company equal employment opportunities to reputed company reputed company applicants without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally reputed company. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship. #LI-NH2 Apply tot his job Apply To this Job