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Senior Healthcare Coding Specialist

2 months ago

Atlanta, Georgia, United States MultiPlan Full time

About MultiPlan:

At MultiPlan, we are committed to fostering a vibrant team of forward-thinking professionals. Our mission is straightforward - we aim to transform the cost landscape in healthcare for everyone. Our unwavering commitment to excellence in service extends to all our stakeholders, both internal and external, propelling us to consistently surpass expectations. We are purposefully audacious, we encourage innovation, we cultivate accountability, we advocate for diversity, and we empower one another to realize our collective potential.

Position Overview:

The Senior Medical Coding Specialist is responsible for analyzing high-value and intricate claims by utilizing research, coding standards, industry insights, and federal regulations to guarantee accurate billing practices. The incumbent will conduct reviews to identify discrepancies in billing quality and monitor bills for precision and compliance.

Key Responsibilities:

  1. Evaluate and scrutinize complex inpatient, outpatient, and practitioner billing for medical appropriateness of treatment; assess charges across various revenue centers while considering patient diagnosis, procedures, age, and facility type, including any additional information deemed potentially beneficial in the payment integrity and/or negotiation process.
  2. Support management in the daily operations and workflows within the department.
  3. Design and engage in the clinical and coding education of coders, negotiators, and physicians, which includes orientation, training, and mentoring of both new and existing staff.
  4. Facilitate daily claim completion meetings with the coding operations team; discuss complex cases, provide feedback on previous day claim reviews, and develop and implement new coding protocols.
  5. Enhance successful coding operations through the application of certified knowledge along with continuous professional development and ongoing coding research.
  6. Offer general support to clinical team members, acting as a resource and subject matter expert (SME).
  7. Monitor turnaround times for multiple applications and provide recommendations for process efficiencies.
  8. Utilize independent decision-making skills to review claims after business hours to meet deadlines.
  9. Apply national coding standards and regulations to billed claims.
  10. Investigate and review individual claims, claim trends, or detailed itemized bills, operative notes, and other documentation as necessary.
  11. Collaborate with physician and analytics teams to create, enhance, or propose new coding edits, claim factors, guidelines, and other relevant reference materials.
  12. Monitor, research, and summarize trends, coding practices, and regulatory changes.
  13. Employ clinical judgment and a high level of expertise along with analytical skills in reviewing the most challenging and complex cases; including conducting additional research as needed.
  14. Communicate clinical, coding, and reimbursement findings to colleagues and management in a clear and organized manner.
  15. Assess the performance of both newly hired and existing staff.
  16. Assist in the education of staff regarding claims, suggest additional negotiation talking points or tools, develop instructional design when applicable, and communicate overall industry or regulatory changes affecting the department.
  17. Partner with management to drive departmental goals and objectives.
  18. Collaborate, coordinate, and communicate across various disciplines and departments.
  19. Ensure compliance with HIPAA regulations and requirements.
  20. Demonstrate commitment to the Company's core values.
  21. Note: Due to the exposure to PHI sensitive data, this role is classified as a High-Risk Role.
  22. The responsibilities outlined above are not exhaustive. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Job Scope:

This position operates independently with minimal supervision to fulfill the outlined responsibilities. The incumbent manages multiple projects simultaneously, and the work is varied and complex. More intricate issues are escalated to higher levels. The incumbent adheres to established procedures and applies knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details when executing all job functions.