Senior Medical Coding Specialist

4 days ago


Reston, Virginia, United States System Soft Technologies Full time
Job Title: Senior Medical Coder

SCOPE OF THE PROJECT:

This project is a multi-year effort focused on providing consulting services to operations and policy staff for the current MMIS.

The current position's focus and priority is the continued support of serving as a subject matter expert (SME), building knowledge that allows policy and process owners to make the best recommendations for Medicaid members and providers.

A long-term plan includes participating and providing guidance in the administrative approach for the replacement management system.

It is necessary to build and sustain a strong Medical Coding staff who understands coding, aids staff in understanding CPT/HCPCS and ICD-10 coding and applies the codes correctly within the Reference Administration sub-system.

Key Responsibilities:
  • Assist with the CPT/HCPCS and ICD-10 code maintenance.
  • Initiate annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
  • Perform initial review of codes to determine scope of changes.
  • Prepare listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
  • Conduct meetings with Agency personnel, stakeholders, and process owners.
  • Participate in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
  • Serve as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
  • Research business rules, requirements, and models to complete initial analysis and recommendations.
  • Maintain business rules, requirements, and models in a repository.
  • Collaborate with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
Requirements:
  • Five years' experience in healthcare insurance; medical review, program integrity, or appeals.
  • Five years' experience working with IT developers/programmers in a payor environment.
  • Five years' experience Medical Coding in payer environment.
  • Strong knowledge of ICD/CPT/HCPCS translation.
  • Strong knowledge of ICD/CPT/HCPCS coding methodologies.
  • Extensive knowledge of anatomy, physiology, pharmacology, and medical terminology.
  • Superb written and oral communications skills, strong proficiency in English is required.
  • Strong knowledge of formal business process documentation.
  • Ability to effectively communicate with executive management, line management, project management, and team members.
Preferred Skills:
  • Experience in policy remediation.
  • Claims processing systems experience.
  • Knowledge of Microsoft Office (Word, Excel, PowerPoint, Optum Encoder and or other medical coding software programs).
Education and Certifications:

RN or LPN in South Carolina and Medical Coding Certification

Current nursing license in South Carolina. Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam.



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