Medical Coding Specialist

1 day ago


Baltimore, Maryland, United States Three Point Solutions Full time
Job Title: Medical Coding Specialist

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.
Requirements:
  • 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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