Medical Coding Analyst, Senior

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience.  Some of our offerings include:

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

• Annual incentive bonus plan based on company achievement of goals

• Time away from work including paid holidays, paid time off and volunteer time off

• Professional development courses, mentorship opportunities, and tuition reimbursement program

• Paid parental leave and adoption leave with adoption financial assistance

• Employee discount program

Job Description Summary:

Researches, coordinates, analyzes, and resolves complex claim inquiries to align with coding requirements for established medical/payment policy. Follows company guidelines and refers issues as appropriate to medical policy and payment policy for additional review. Acts as a medical review subject matter expert on issues relating to system edit impacts on medical reviews, as well as reimbursement. Must possess an in-depth understanding of medical coding, provider reimbursement, and medical policy.

Job Description

• Researches and reviews written claim inquiries submitted to the company for determination regarding claims bundling and coding issues. This includes reviewing complex operative reports and provider information regarding procedures and requesting provider documentation as needed to complete reviews.
• Reviews appropriate use of modifiers and codes being submitted by providers. Provides coding perspective and refers for additional review as appropriate per Medical Policy.
• Identifies incorrect or inconsistent computer programming edit information within FACETS and ClaimsXten, and coordinates resolution with appropriate staff members.
• Collaborates with Provider Solutions and Provider Operations and Services Support regarding system edits that impact claim inquiry reviews sent to Medical Management. This includes assisting to identify root causes,and recommends efficiencies to improve provider and member experience.
• Collects relevant data to aid reporting, project tracking and staff performance management.
• Provide system update support regarding Medical Management prior authorization tables.
• Acts as medical coding subject matter expert and will organize coding related training for nurses on the medical review and prior authorization team.
• Prepares outcome reports that show findings from project/contract activities. Effectively communicates project finding to internal and external clients
• Provides analysis and recommendations to Provider Payment, Provider Solutions, and Medical Policy team as it relates to coding, bundling, modifiers, clinical edits, and enforcements
• Builds relationships with other departments within Blue KC to successfully drive accurate and timely initiatives related to medical codes and reimbursement.

Minimum Qualifications

• Associate’s degree in applied sciences, and 2-3 years of experience in a medical insurance or healthcare environment; or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job. 
• Must have at least 3 years medical coding experience
• Coding certification
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, operative reports or governmental regulations.
• Ability to write reports, business correspondence and business manuals.
• Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages.
• Ability to apply basic concepts of algebra.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions and deal with several abstract and concrete variables.
• Intermediate level keyboard skills.
• Intermediate knowledge of and skill using Microsoft Windows.
• Intermediate level knowledge of Microsoft Office Word, Excel, and Access, or similar PC-based programs.
• Intermediate knowledge of medical terminology and medical claims diagnosis and procedure coding.

Preferred Qualifications

• 10 years of experience with procedural coding,