Managed Care Coding Analyst

2 weeks ago

Pensacola, Florida, United States West Florida Medical Center Clinic PA Full time
Job Overview

POSITION SUMMARY

The role involves managing preauthorization processes for inpatient admissions, outpatient surgical procedures, and advanced imaging services. This includes handling insurance follow-ups related to coding denials, identifying potential revenue enhancements through reimbursement analysis, and engaging with MedPro Representatives to address carrier-related concerns. The position also requires responding to inquiries from patients, Practice Managers, and medical departments, along with executing additional tasks as directed by the immediate supervisor.

KEY RESPONSIBILITIES

  • Utilizes the Managed Care Work list to monitor the status of requests, ensuring timely authorizations are obtained at least one week prior to scheduled services whenever feasible.
  • Analyzes Eligibility and Authorization reports for the Diagnostic Center.
  • Reviews data in the Managed Care Work list to propose enhancements for operational efficiency.
  • Conducts coding responsibilities with minimal oversight, effectively managing time to deliver a substantial volume and quality of work.
  • Addresses coding-related claim denials by evaluating source documentation to ascertain accurate CPT, ICD-9-CM, ICD-10-CM, and/or CPT/HCPCS codes and/or modifiers. Adjusts codes as necessary and provides recommendations in claim notes regarding the re-filing or adjustment of claims. Monitors activities to identify trends among carriers and advises the department director accordingly.
  • Regularly reviews and resolves Diagnostic Center ALI and Context claim coding discrepancies.
  • Processes Denial Reports for the Diagnostic Center.
  • Uploads Diagnostic Center documentation into the electronic medical record system on a daily basis.
  • Updates patient accounts with accurate insurance details.
  • Proactively evaluates carrier trends and communicates findings to relevant personnel.
  • Facilitates effective communication among stakeholders affected by coding issues to achieve timely resolutions.
  • Stays updated on insurance requirements and industry developments related to coding.
  • Engages in ongoing coding education through seminars, online courses, industry newsletters, and bulletins.
  • Addresses inquiries from patients or medical staff regarding insurance or account activity in a professional and courteous manner.
  • Completes assigned reports and projects within specified deadlines.
  • Maintains a collaborative and positive working relationship with both internal and external stakeholders.
  • Communicates professionally with medical office staff and colleagues.
  • Remains informed about current insurance carrier requirements concerning service pre-authorizations.
  • Ensures that backup personnel are adequately trained to handle ALI, Context, Eligibility and Authorization, and Denial reports during absences.
  • Acts as a Patient Service Representative in the absence of designated personnel.
  • Performs additional duties as assigned by the supervisor.

CORPORATE CULTURE EXPECTATIONS

  • Adhere to established corporate and departmental policies and procedures.
  • Participate in all mandatory corporate and departmental training sessions.
  • Uphold the organization's Purpose, Values, and Vision.
  • Comply with Corporate Culture Expectations.
  • Willingly perform other assigned duties as needed.

EDUCATION AND EXPERIENCE REQUIREMENTS

  • High school diploma or GED is the minimum educational requirement.
  • Certification as a Certified Professional Coder or Certified Coding Associate is required.
  • A minimum of two years of experience in the healthcare insurance sector is necessary.

SKILLS AND ABILITIES

  • Exhibit strong customer service skills, interpersonal abilities, meticulous attention to detail, and excellent verbal and written communication skills.
  • Demonstrate integrity and character, with a willingness to embrace change and positively impact patients and colleagues.
  • Ability to collaborate effectively with staff at all organizational levels.
  • Capable of working the hours necessary to thoroughly complete job responsibilities.
  • Possess good organizational skills and adaptability to frequent changes.
  • Proficient in the use of software applications such as PPP, Horizon System, Microsoft Excel, and Word.
  • Fluent in English, both written and spoken.
  • Able to communicate effectively with individuals from diverse socio-economic backgrounds.
  • Exhibit active listening skills, demonstrating the ability to understand and respond appropriately.
  • Maintain a professional demeanor while respecting patient privacy.
  • Commitment to safeguarding confidential information and records.
  • Ability to maintain focus while working in close proximity to others.

PHYSICAL AND EMOTIONAL REQUIREMENTS

  • Physical strength requirements are sedentary, involving up to 10 pounds of force occasionally.
  • Occasional standing/walking is required, existing up to one-third of the time.
  • Frequent keyboarding and dexterity activities are necessary, occurring three-quarters of the time.
  • Ability to view a computer screen for extended periods.
  • Capable of performing repetitive hand and finger motions.
  • Ability to work in various positions (standing, sitting, bending, and walking) for extended durations.
  • Effective verbal communication skills are essential.
  • Must possess adequate coping skills to manage daily work pressures.
  • Ability to remain calm and professional under workload and time constraints.

WORK ENVIRONMENT

  • Frequent interruptions in daily functions/schedule are expected.
  • Availability to assist customers and staff throughout the day is required.
  • Extended hours may be necessary to meet departmental needs.

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