Shared Health - Coding Process Enterprise Consultant

Job Responsibilities

• Maintains applicable department databases and prepares reports for management.
• Participates in the research, analysis, implementation, problem resolution, recommendations, maintenance and coordination of coding process improvement across the organization.
• Detects and reports potential provider coding educational opportunities and/or fraudulent/aberrant billing practices, and distributes issue resolution as necessary.
• Participates in the implementation of coding, reimbursement, and billing changes with all areas of the Enterprise identified by business needs.
• Serves as an advisor regarding the process related to end-to-end code set dissemination on various corporate committees, workgroups, and/or sub-workgroups.

Job Qualifications

Education

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

Experience

• 5 years - Experience with Medical/Clinical Coding

Skills\Certifications

• Certified Professional Coder (CPC)

• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Proven analytical and problem solving skills and ability to perform non-routine analytical tasks
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Ability to build relationships with stakeholders in multiple divisions/functions

The ideal candidate for this position will have extensive experience in Medicare claims processing in addition to significant coding expertise. Strong analytic skills and a drive to identify solutions is critical. The position will review data and investigate claims payment processing and Medicare guidelines to insure the health plan is properly paying claims according to Medicare guidelines and health plan policies.

In this role, you will have the opportunity to identify efficiencies and potential cost savings to the health plan.

This role will require an individual to be a self-starter who can reach out to different teams within the Enterprise to ask questions and identify potential issues. The individual in this role will routinely meet with executive leadership of the health plan and executive leadership from our sister Medicare Advantage products within the Enterprise.

Medicare Claims Payment Experience is strongly preferred.  

Number of Openings Available:

1

Worker Type:

Employee

Company:

SHI Shared Health, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee