Medical Coding Specialist

3 weeks ago


Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time

Job Summary

CareFirst BlueCross BlueShield is seeking a skilled Medical Coding Specialist to join our Special Investigations Unit. As a key member of our team, you will play a critical role in ensuring reimbursement and medical policy guidelines are adhered to.

Key Responsibilities

  • Provide expert knowledge to support effective guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions.
  • Utilize coding expertise, combined with medical policy, credentialing, and claim processing rules knowledge to determine appropriate billing and code submissions while not compromising payment integrity.
  • Consult on proper coding rules to ensure appropriate and proper use of CPT and ICD10 codes.
  • Conduct complex business and operational analyses to assure payments are in compliance with contract.
  • Support and contribute to the development and refinement of effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality outcomes while not compromising payment integrity.

Requirements

  • High School Diploma or GED.
  • CCS-Certified Coding Specialist or Certified Coder (CCS or CPC)-AHIMA or AAPC.
  • 3 years experience in risk adjustment coding, ambulatory coding and/or CRC coding experience in managed care; state or federal health care programs; or health insurance industry experience.

Preferred Qualifications

  • Bachelor's degree in related discipline.
  • Experience in medical auditing.
  • Experience in training/education/presenting to large groups.
  • Experience in revenue cycle management and value-based reimbursement/contracting models and methodologies.

What We Offer

CareFirst BlueCross BlueShield offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.



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