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Providence Health & Services · 1 month ago

Coding Policy Analyst Remote

United States

Full-time

Remote

Senior Level

$29.56/hr - $57.56/hr

5+ years exp

Providence Health & Services is a comprehensive health care organization that focuses on patient-centered care. The Coding Policy Analyst will coordinate coding policies, respond to appeals, and ensure compliance with coding guidelines and regulations while serving as a subject matter expert within the organization.

Health CareHospitalInsuranceMedicalNon ProfitPersonal Health

Responsibilities

Coordinate technically detailed work that has a significant impact on all operations and information systems within Providence Health Plan (PHP)

Update and create Coding Policies and associated edit configurations within the PHP claims editing system

Reply to provider and member appeals and provide appropriate CPT, CMS, specialty society, Coding Policy, and/or other official documented rationale for Coding Policy edits

Monitor changes to codes, coding guidelines and regulations, and coding edits from external agencies such as AMA, CMS, Medicaid, and specialty societies

Assist with implementation of changes to the claims adjudication and editing software

Serve as a coding subject matter expert to other departments within PHP for questions about CPT, HCPCS, and ICD-10 codes, as well as coding guidelines and regulations

Work closely with the Benefits Management Team and Regulatory Department to ensure coding edits are applied in a manner consistent with member benefits and all state and federal insurance regulations

Qualification

CPT codingCoding certificationCoding guidelines knowledgeMicrosoft OfficeWriting skillsDetail-orientedTeam collaboration

Required

Coding certification through AAPC (CPC) or AHIMA (CCS) upon hire

5 years of experience directly related to CPT coding from chart extraction with a health care provider, a health insurance company, or a capitated managed care company

5 years of excellent writing and grammar skills required

5 years of demonstrated experience in detailed coding applications, as well as Microsoft Office capabilities, such as Excel, Word, and Access