Coding & Claims Coordinator

3 weeks ago


Baton Rouge, Louisiana, United States The University of New Orleans Full time
Job Summary

The University of New Orleans is seeking a highly skilled Coding & Claims Coordinator to join our team. As a key member of our Design and Covered Services department, you will play a critical role in ensuring accurate reimbursement between managed care organizations and providers.

Key Responsibilities
  • Review and verify accurate CPT, ICD-10, and HCPCS reimbursement between managed care organizations and providers.
  • Analyze reports on denied claims, documentation, and coding issues for review by management.
  • Review documentation for completeness, accuracy, and compliance.
  • Ensure contract compliance with managed care organizations and provide timely and responsive support.
  • Provide technical guidance to providers, external stakeholders, and managed care organizations to improve the reimbursement process.
  • Serve as a liaison with managed care organizations and LDH MMIS, Eligibility, and Systems staff to address claims issues.
  • Maintain knowledge of HIPAA guidelines and regulations.
  • Review monthly denied claims reports and provide analysis to the provider relations program manager.
  • Act as the department resource for coding questions and training.
  • Review Network Adequacy reports and stay up-to-date with CMS guidelines.
  • Assist with administering the provider independent review process to ensure compliance with Act 349 of the 2017 Regular Legislative Session.
  • Assist with oversight of the medical necessity vendor contract and prepare materials for Independent Review Panel meetings.
  • Serve as technical lead for the implementation of a provider network adequacy analytics tool.
  • Manage the MCO policy submission process, including operationalizing Act 319 of the 2019 Regular Legislative Session.
Requirements
  • Bachelor's Degree or 6 years of professional experience in lieu of degree.
  • Excellent analytical skills, effective organizational, and time management skills.
  • Able to independently initiate communication with stakeholders.
Preferred Qualifications
  • Bachelor's Degree in Public Health, Community Health, or Healthcare Management.
  • Minimum 1 year of experience with Medicaid program support or working with insurance/Medicare.
  • Minimum 1 year of experience in reporting and statistical analysis.
  • Working knowledge of provider claims, including claims submittal requirements, posting payments, recoupments, and working denials.
  • Certificate in medical coding (AHIMA or AAPC).
What We Offer

The University of New Orleans offers a competitive salary and benefits package, as well as opportunities for professional growth and development.

We are an equal opportunity employer and welcome applications from diverse candidates.



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