Medical Coding Subject Matter Expert and Consultant

4 weeks ago

Washington, Washington, D.C., United States Information Resource Group Full time
Job Summary:

Information Resource Group seeks a Medical Coding Subject Matter Expert and Consultant to support the continued growth and development of our healthcare services. As a key member of our team, you will be responsible for providing expertise in medical coding methodologies, Medicaid policy, and related topics.

Key Responsibilities:

Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
Performs initial review of codes to determine scope of changes.
Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
Conducts meetings with Agency personnel, stakeholders, and process owners.
Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
Researches business rules, requirements, and models to complete initial analysis and recommendations.
Maintains business rules, requirements, and models in a repository.
Collaborates 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.
5 years' experience working with IT developers/programmers in a payor environment.
5 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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