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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 being a vibrant collective of forward-thinking professionals. Our mission is straightforward - we aim to transform the cost landscape in healthcare for everyone. Our commitment to excellence in service extends to all our stakeholders, both internal and external, motivating us to consistently surpass expectations. We embrace boldness, encourage innovation, foster accountability, celebrate diversity, and empower one another to realize our shared potential.

Position Overview:

The Senior Medical Coding Specialist is responsible for analyzing high-value and intricate claims by utilizing research, coding standards, industry expertise, and federal regulations to ensure 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 considering patient diagnosis, procedures, age, and facility type, along with any additional relevant information that may assist 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, including 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 create and implement new coding protocols.
  5. Drive effective coding operations through the application of certified knowledge and continuous professional development, alongside 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 improvements.
  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. Research and analyze 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, investigate, 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 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 educating 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. This role is considered a High-Risk Role due to exposure to PHI sensitive data.
  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, with work that 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 in all job aspects.