Medical Coding Specialist
1 day ago
About the Role:
We are seeking a highly skilled Medical Coding Specialist to join our team at Three Point Solutions. As a Medical Coding Specialist, you will play a critical role in supporting our value-based reimbursement and medical policy models.
Key Responsibilities:
- Act as an internal expert to provide guidance on quality measure capture and CPT/ICD 10 code use in claims submissions.
- Utilize extensive coding knowledge, medical policy, credentialing, and contracting rules to build guides and resources for providers to maximize quality and STARs outcomes while maintaining payment integrity.
- Consult on coding rules in value-based contracts for quality measure capture and CPT/ICD10 code use.
- Provide input on consequences for financial and incentive models.
- Support alternatives to maximize quality payments and risk adjustment.
- Translate claim language to services in episode or capitated payments.
- Serve as a technical resource and subject matter expert for contract pricing issues.
- Conduct analyses to ensure compliance with contracts and identify improvement areas.
- Provide problem-solving expertise on complex coding and billing issues.
- Contribute to the development of guides and resources for providers.
- Interface with provider groups for training and respond to inquiries.
- Consult with Practice Transformation Consultants, Medical Policy Analysts, and Provider Networks.
- Coding certification required.
- Understanding of authorization to claims process.
- Ability to translate regulatory requirements into authorization claims configuration.
- Experience working with all Lines of Business (LOBs): Medicare, Medicaid, Commercial, ASO.
- Detail-oriented with a strong understanding of CPT code groupings and medical data.
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