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Providence · 1 month ago

Coding Policy Analyst

Portland, OR

Full-time

Onsite

Senior Level

$31.71/hr - $57.56/hr

5+ years exp

Providence is a comprehensive health care organization that focuses on patient-centered care. The Coding Policy Analyst will coordinate and update Coding Policies, respond to provider and member appeals, and ensure compliance with coding guidelines and regulations.

Hospital & Health Care

Responsibilities

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