Senior Medical Coding Specialist

1 month ago

Naperville, United States MultiPlan Full time

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company that helps our customers thrive by interpreting our client's needs and tailoring innovative cost management solutions.

We are MultiPlan and we are where bright people come to shine

The Senior Medical Coding Specialist provides analysis of the highest dollar and most complex claims by applying research, coding standards, industry knowledge and federal regulations to ensure correct billing practices. In this role, incumbent will perform reviews to identify variations from quality of billing as well as to monitor bills for accuracy and compliance.

JOB ROLES AND RESPONSIBILITIES:

  1. Review and analyze complex inpatient, outpatient, and practitioner billing for medical appropriateness of treatment; analyze charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type including any additional information perceived as potentially helpful in the payment integrity and/or negotiation process.
  2. Assist management in the daily operations and processes within the department.
  3. Design and participate in the clinical and coding education of coders, negotiators, and physicians. This includes orientation, training and mentoring of new and existing staff.
  4. Facilitate daily claim completion meetings with coding operations team; discussing complex cases, providing feedback on prior day claim reviews, creating and initiating new coding protocols.
  5. Drive successful coding operations through the application of learned, certified knowledge in addition to continuous professional development and ongoing coding research.
  6. Provide general support to clinical team members, serving as a resource and subject matter expert (SME).
  7. Monitors turnaround times for multiple applications and provides suggestions for process efficiencies.
  8. Uses independent decision making skills to review claims after business hours to meet deadlines.
  9. Apply national coding standards and regulations to claims billed.
  10. Research and review individual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
  11. Collaborate with physician and analytics teams to create, enhance or suggest new coding edits, claim factors, guidelines and other applicable reference materials.
  12. Monitor, research, and summarize trends, coding practices, and regulatory changes.
  13. Apply clinical judgment and high level of expertise along with analytic skills in review of the most challenging and difficult cases; including conducting additional research as needed.
  14. Communicates clinical, coding and reimbursement findings to co-workers and management in a clear, organized manner.
  15. Evaluate performance of both newly hired and existing staff.
  16. Assist with education of staff as it relates to claims, suggest additional negotiation talking points or tools, develop instructional design, when applicable and communicate overall industry or regulatory changes which affect the department.
  17. Partner with management to drive department goals and objectives.
  18. Collaborate, coordinate, and communicate across disciplines and departments.
  19. Ensure compliance with HIPAA regulations and requirements.
  20. Demonstrate commitment to the Company's core values.
  21. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
  22. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:

This position works independently with minimal supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. More complex issues are referred to higher levels. The incumbent follows established procedures and uses knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.


As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

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