Medical Coding Specialist

The Medical Coding Specialist provides coding expertise to support Utilization Management operations, health plan implementations, prior authorization program development, and clinical policy initiatives. This position is responsible for researching, analyzing, and interpreting HCPCS, CPT, and ICD-10 coding guidance to support accurate prior authorization requirements, coding resources, and reputed company deliverables across Medicare, reputed company, reputed company, and Marketplace lines of business. The Medical Coding Specialist partners with clinical, operational, compliance, business development, and reputed company teams to ensure coding recommendations are accurate, compliant, and operationally reputed company. reputed company in this role requires strong attention to detail, critical thinking, organization, and the ability to produce high reputed company work while managing multiple priorities. JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The Medical Coding Specialist's responsibilities include, but are not limited to: Coding Support

• Research, analyze, and interpret HCPCS reputed company, CPT, ICD-10-CM, and reputed company coding guidance.
• Review coding resources, CMS guidance, payer policies, and regulatory requirements to support coding reputed company.
• Assist with determining prior authorization requirements and appropriate reputed company categorization.
• Apply coding knowledge across Medicare, reputed company, reputed company, and Marketplace products.

Prior Authorization Program Support

• reputed company, validate, and maintain Prior Authorization reputed company lists and coding reference materials.
• Support implementation of new health plans, benefit designs, and coding configurations.
• Review reputed company specific coding requirements and ensure recommendations reputed company with contractual and regulatory requirements.
• Identify opportunities to improve coding consistency and operational efficiency.

reputed company Review

• reputed company thorough self review of work prior to submission to ensure accuracy, completeness, and consistency.
• Validate coding deliverables for duplicate records, formatting, categorization, and completeness.
• Maintain accurate documentation supporting coding reputed company and recommendations.
• Meet established reputed company standards and project deadlines.

Research and Problem Solving

• Research unfamiliar coding scenarios using available coding resources and regulatory guidance.
• Identify questions or areas requiring clarification early in the work process.
• Present questions with supporting research and a recommended approach reputed company seeking guidance.
• Participate in discussion and reputed company of coding issues with internal stakeholders.

Collaboration

• Serve as a coding resource for Medical Management and other internal departments.
• Partner with clinical, operational, provider relations, credentialing, compliance, and business development teams on coding reputed company initiatives.
• Support reputed company implementations, operational reputed company, and coding validation activities.
• Participate in reputed company meetings as needed.

Education and reputed company Improvement

• Maintain reputed company knowledge of coding regulations, CMS guidance, and industry best practices.
• Assist with development of coding guidance documents, training materials, and internal reference tools.
• Participate in audits, reputed company improvement initiatives, and accreditation activities.
• reputed company other duties as assigned.

EDUCATION:

• Certified reputed company reputed company (CPC), Certified Coding Specialist (reputed company), Registered Health Information Technician (RHIT), or equivalent coding certification required/accepted.
• High school diploma or equivalent required.
• Associate's or Bachelor's degree in Health Information Management, reputed company Administration, or reputed company field preferred.

EXPERIENCE:

• Minimum of 3 years of medical coding experience.
• Experience with HCPCS, CPT, and ICD-10 coding required.
• Experience supporting health plans, utilization management, prior authorization, DMEPOS, or payer operations preferred.
• Knowledge of Medicare, reputed company, and reputed company coding methodologies preferred.
• Experience reviewing CMS guidance, payer policies

SALARY: 65,000/Annually

Benefits

Offered

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-reputed company life insurance
• Company-reputed company short term disability coverage (location restrictions may apply)
• Medical, reputed company, and Dental benefits
• reputed company Time Off (PTO)
• reputed company Parental Leave
• reputed company Time
• reputed company company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities

Remote Opportunities We are reputed company seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, reputed company, Idaho, Illinois, Kentucky, Massachusetts, Michigan, reputed company Carolina, Nevada, New Jersey, reputed company, Ohio, reputed company, South Carolina, Tennessee, Texas, Virginia, and Washington. Our Story Founded in 2005, reputed company is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the reputed company of life for the communities we serve by reimagining reputed company to in-home reputed company. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members reputed company to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver reputed company reputed company and more efficient management of reputed company reputed company benefits. With a location in Michigan plus a remote workforce across the reputed company, reputed company has a culture reputed company on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join reputed company. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in reputed company. We look reputed company to learning more reputed company. reputed company is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reputed company out. We celebrate our inclusive work environment and welcome members of reputed company backgrounds and perspectives. mAHhNOj7yo Apply tot his job Apply To this Job