Coding Specialist - Benefit and Contract
Company: Inland Empire Health Plans
Location: Rancho Cucamonga
Posted on: January 8, 2021
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Job Description:
Position Summary/PositionUnder the direction of the Claims
System Configuration Manager, the Benefit and Contract Coding
Specialist performs on-going review of all applicable state and
federal regulations, as well as internal contracts for alignment
with claim adjudication related system configuration. This position
is responsible for analyzing and codifying new contracts, Divisions
of Financial Responsibilities (DOFRs), and Medi-Cal and Medicare
benefits in compliance with AMA and regulatory guidelines. The
incumbent may also assist in reviewing and resolving DHCS and CMS
encounter rejection data as it related to coding and billing. The
Benefit and Contract Coding Specialist reviews information related
to claims reconciliation and assists in IEHP's efforts to maximize
Provider reimbursement and clean-claim standards. The Specialist is
also responsible for assisting the Provider Services Department in
identifying opportunities for improvement in provider billing
practices. Major Functions (Duties and Responsibilities)1. Performs
ongoing claims adjudication review and coding assistance to the
Claims System Configuration team.2. Conducts research for coding
regulations and requirements related to Medi-Cal and Medicare
benefits.3. Analyzes IEHP claims and encounter data to identify
incomplete or inaccurate configuration and/or incorrectly billed
claims.4. Works closely with the Claims System Configuration Team,
Contracting department, and Claims department to provide coding
support related to contracts and benefits.5. Develops and maintains
tracking log for Medi-Cal Local Codes and other coding
crosswalks.6. Assist with all regulatory, internal, external or
vendor audits as required.7. Notifies Claims System Configuration
team of new codes and regulations.8. Assist in the implementation
and maintenance of coding rules to be administered in either
McKesson or Meditrac.9. Codify DOFRs, contracts, and benefits.10.
Demonstrate a commitment to incorporate LEAN principles into daily
work. Experience Qualifications3 years of medical coding experience
required. Preferred ExperienceManaged Care Coding experience
preferred. Contract coding experience preferred. Encounter or HCC
coding experience preferred. Education QualificationsHigh School
Diploma or GED required. Professional CertificationAHIMA or AAPC
Coding Certification required.CCS-P or CPC-P preferred. Drivers
License Required Yes, must have a valid California Driver's
License. Knowledge RequirementKnowledge of coding for both Medi-Cal
and Medicare services. Knowledge of coding processes, guidelines
and working knowledge of Centers for Medicare & Medicaid Services
(CMS) as well as Department of Health Care Services (DHCS).
Knowledge of CPT, HCPCS, and ICD-10 guidelines are
required.Knowledge in clinical processes and methodology concepts
as they relate to all lines of business and Part D plans is
preferred. Knowledge of claims processing and/or basic system
configuration processes preferred. Knowledge of Medi-Cal local
codes preferred. Skills RequirementExcellent written, oral and
presentation skills, proficiency in Microsoft Word, Excel, and
other computer applications. Abilities RequirementAbility to take
general direction and manage complex projects within deadlines.
Must have attention to detail and the ability to organize and
prioritize standard work. Commitment to Team CultureThe IEHP Team
environment requires a Team Member to participate in the IEHP Team
Culture. A Team Member demonstrates support of the Culture by
developing professional and effective working relationships that
include elements of respect and cooperation with Team Members,
Members and associates outside of our organization. Working
ConditionsMust have reliable transportation, with a current
automobile insurance, and a current state-issues driver's license.
While performing the duties of this job, the employee is
occasionally required to stand; walk; sit; use hands and fingers,
handle, or feel objects, tools or controls; reach with hands and
arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or
hear; and taste or smell. The employee must occasionally life or
move up to 25 pounds. Specific vision abilities required by the job
includes close vision, distance vision, color vision, peripheral
vision, depth perception and the ability to adjust focus.Starting
Salary: $66,040.00 - $84,219.20Pay rate will commensurate with
experienceInland Empire Health Plan (IEHP) is the largest
not-for-profit Medi-Cal and Medicare health plan in the Inland
Empire. We are also one of the largest employers in the region.
With a provider network of more than 6,000 and a team of more than
2,000 employees, IEHP provides quality, accessible healthcare
services to more than 1.2 million members. And our mission and core
values help guide us in the development of innovative programs and
the creation of an award winning workplace. As the healthcare
landscape is transformed, we're ready to make a difference today
and in the years to come. Join our Team and Make a Difference with
us! IEHP offers a Competitive salary and a benefit package with a
value estimated at 35% of the annual salary, including medical,
dental, vision, team bonus, and retirement plan.
Keywords: Inland Empire Health Plans, Rancho Cucamonga , Coding Specialist - Benefit and Contract, Other , Rancho Cucamonga, California
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