Benefit Intent and Coding, Senior

Your Role

The Benefit Intent team is responsible for providing the benefit coding for Commercial, Medicare and Medi-Cal lines of business. The Benefit Intent Senior Coding Analyst will report to the Senior Manager for Benefit Intent. In this role you will Perform benefit coding to support Evidence of Coverage, Medicare or Medi-Cal benefits and State or Federal Mandated benefits. This role will also provide subject matter support for benefit coding for internal and external business partners.

Your Work

In this role, you will:

• Provide expertise in support of the application of the industry standard codes for benefit design or benefit coding
• Research and prepare benefit files using industry standard codes that meet the intent of the benefit language for internal documents such as Evidence of Coverage documents, legislative (state and federal) mandates, Summary of Benefits or other health plan documents
• Provide recommendations to internal and external customers as benefit intent coding subject matter expert
• Perform regular updates to benefit policies and provider manuals
• Maintain coding files and logs as required 
• Provide coding expertise in support of the application of the industry standard codes for benefit design or benefit coding specific to Commercial, Medicare, and California State Medi-Cal lines of business
• Provide problem management recommendations on correct application of benefits intent based on industry and internal research
• Provide expert input to quarterly and annual industry standard code maintenance for multiple systems in support of product and benefit impacts
• Manage Provider Manual content and support communication related to product and benefit intent as assigned
• Support testing to verify benefit coding performs as designed

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 5 years of prior relevant experience
• AHIMA Certified CCS or CCS-P required or AAPC Certified CPC, COC or CIC
• Generally, requires 5-8 years of directly related professional experience and possesses deep technical abilities
• Medicare experience is required (CA State Medicaid experience will be considered)
• Work history in one or more of the following:
  • 3 years of Provider billing experience in Medicare and California State Medi-Cal in a lead, supervisory or management role or
  • 2 years in a payor environment working directly with payment quality and accuracy in a claims processing, provider contracting or audit capacity or 2 years in a compliance or audit function within a healthcare system
• Strong level research and analytical skills into industry and internal sources
• Working knowledge of provider billing practices and standards, including in-depth knowledge of professional and facility claims processing
• Subject Matter expert in Medicare and Commercial Insurance programs requirements
• Some knowledge of Health Care Reform/ACA mandate requirements
• Strong writing and communication skills
• Able to independently use Microsoft Office products (Excel, Word, Outlook, Access)