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Coding Analyst, Senior Job
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| Employer Name: |
SpiderID: 13127097 |
| Location: Rancho Cordova, California |
Date Posted: 12/21/2022 |
| Wage: Negotiable |
Category: Insurance |
| Job Code: 17002F1-2191 |
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Job Description:
 Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
R esponsibilities:
• Provides expertise in support of the application of the industry standard codes for benefit design or benefit coding.
• Provides expert input to quarterly and annual industry standard code maintenance for multiple systems in support of product and benefit impacts.
• Researches and prepares 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.
• Researches and respond to support benefit intent questions during plan design.
• Provides Product and Benefit support as required for the development of payment or medical polices when there are impacts to benefits.
• Provides problem management recommendations on correct application of benefits intent based on industry and internal research.
• Provides recommendations to internal and external customers as benefit intent coding subject matter expert.
• Manage Provider Manual content and support communication related to product and benefit intent as assigned.
• Perform updates to the internal software/ applications for benefits as needed.
• Complete regular updates to Benefit Policies as changes occur.
• Support testing to verify benefit coding performs as designed.
Qualifications:
Education/Requirements:
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Bachelors' degree required.
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AHIMA Certified CCS or CSS-P required.
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Generally requires 5-8 years of directly related professional experience and possesses deep technical abilities.
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Work history in one or more of the following:
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3 years of Provider billing experience in a lead, supervisory or management role or;
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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.
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Functions well in an environment where delivery on time-sensitive projects is required.
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Ability to lead cross-functional meetings to achieve cross-functional alignment.
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Strong level research and analytical skills into industry and internal sources.
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Broad, but not in-depth knowledge of payor claims processing systems, benefits, facility and physician contracts and medical and payment policy.
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Working knowledge of provider billing practices and standards, including in-depth knowledge of HCFA 1500 and UB-04 claims data.
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Some knowledge of Health Care Reform/ACA mandate requirements.
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Strong writing and communication skills.
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Able to independently use Microsoft Office products (Excel, Word, Outlook, Access).
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:
Contact Information:
| Contact Name: Blue Shield of California |
Company Type: |
| Company: Blue Shield of California |
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