Managed Care Coding Analyst

2 weeks ago

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

POSITION SUMMARY

The Managed Care Coding Specialist is tasked with overseeing the processes related to securing preauthorization for various medical services, including inpatient admissions, outpatient surgical procedures, and advanced imaging tests. This role also involves addressing coding denials through diligent insurance follow-up, identifying potential revenue enhancements based on reimbursement trends and audits, and collaborating with MedPro Representatives to resolve carrier-related issues. The specialist will also provide support to patients, Practice Managers, and medical departments by addressing inquiries and performing additional duties as assigned by the direct supervisor.

KEY RESPONSIBILITIES

  • Utilizes the Managed Care Work list to monitor the receipt, delays, and completion of requests, prioritizing tasks to secure authorizations at least one week before the scheduled service date when feasible.
  • Analyzes eligibility and authorization reports for the Diagnostic Center.
  • Examines data in the Managed Care Work list to propose enhancements for operational processes.
  • Conducts coding tasks with minimal oversight, effectively managing time to produce a high volume and quality of work.
  • Handles coding-related claim denials by reviewing 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 whether to re-file or modify claims. Monitors activities to detect carrier trends and advises the department director accordingly.
  • Reviews and addresses coding edits for Diagnostic Center ALI and Context claims on a daily basis.
  • Manages Denial Reports for the Diagnostic Center.
  • Uploads Diagnostic Center files into the electronic medical record system daily.
  • Updates patient accounts with accurate insurance information.
  • Proactively identifies carrier trends and communicates findings to relevant personnel.
  • Facilitates effective communication among stakeholders involved in coding-related issues to achieve timely resolutions.
  • Stays current with insurance requirements and industry news/policy changes pertinent to coding.
  • Engages in ongoing coding education through seminars, online training, and industry publications.
  • Responds to inquiries from patients and medical department staff regarding insurance or account activity in a professional and courteous manner.
  • Completes assigned reports and projects within established deadlines.
  • Maintains a positive and collaborative working relationship with both internal and external clients.
  • Communicates professionally with medical office staff and colleagues.
  • Remains informed about current insurance carrier requirements for service pre-authorization.
  • Ensures that backup personnel are adequately trained to manage 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 manager.

CORPORATE CULTURE RESPONSIBILITIES

  • Adhere to established corporate and departmental policies and procedures.
  • Participate in all required corporate and departmental training sessions.
  • Uphold the organization’s Purpose, Values, and Vision.
  • Comply with Corporate Culture Responsibilities.
  • Carry out other assigned duties with a positive attitude.

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 preferred.

SKILLS AND ABILITIES

  • Exhibit strong customer service skills, interpersonal abilities, 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 necessary hours to thoroughly and accurately fulfill job responsibilities.
  • Possess good organizational skills and adaptability to frequent changes.
  • Proficient in the use of relevant software applications, including 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 and the ability to engage appropriately in conversations.
  • Maintain a professional demeanor and respect patient privacy.
  • Commitment to safeguarding confidential information and records.
  • Ability to maintain focus while working in close proximity to others.

PHYSICAL REQUIREMENTS

  • Strength: Sedentary (exerting up to 10 pounds of force occasionally).
  • Standing/Walking: Occasionally; activity exists up to 1/3 of the time.
  • Keyboarding/Dexterity: Frequently; activity exists from 3/4 of the time.
  • Ability to look at a computer screen for extended periods.
  • Ability to perform repetitive hand and finger motions.
  • Ability to work in various positions (standing, sitting, bending, and walking) for extended periods.
  • Effective verbal communication skills are required.
  • Visual and auditory capabilities are necessary.

EMOTIONAL REQUIREMENTS

  • Must demonstrate stable work behaviors consistently.
  • Possess adequate coping skills for individual challenges.
  • Ability to remain calm and professional under workload or time constraints.
  • Must be able to work under stress while maintaining professionalism.

WORK ENVIRONMENT

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

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