Medical Coding Specialist

1 week ago


Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time
Job Summary

CareFirst BlueCross BlueShield is seeking a highly skilled Medical Coding Specialist to join our Special Investigations Unit. As a key member of our team, you will utilize your expertise in risk adjustment coding, ambulatory coding, and CRC coding to ensure accurate and compliant billing and code submissions.

Key Responsibilities:

  • Provide expert guidance on proper coding rules and regulations to ensure accurate and compliant billing and code submissions.
  • Consult with various teams, including medical policy and colleagues, to interpret coding and documentation language and respond to inquiries from providers.
  • Stay up-to-date on coding rules and standards, and apply this knowledge to ensure compliance and accuracy in billing and code submissions.
  • Collaborate with the team to develop and refine effective guides and resources for providers on expected methodologies for billing and code submissions.

Requirements:

  • High School Diploma or GED.
  • CCS-Certified Coding Specialist or Certified Coder (CCS or CPC)-AHIMA or AAPC.
  • 3 years experience in risk adjustment coding, ambulatory coding, and/or CRC coding experience in managed care; state or federal healthcare programs; or health insurance industry experience.

Preferred Qualifications:

  • Bachelor's degree in a related discipline.
  • Experience in medical auditing.
  • Experience in training/education/presenting to large groups.
  • Experience in revenue cycle management and value-based reimbursement/contracting models and methodologies.

Knowledge, Skills, and Abilities:

  • Knowledge of billing practices for hospitals, physicians, and/or ancillary providers.
  • Knowledge of contracting and claims processing.
  • Knowledge and understanding of medical terminology to address codes and procedures.
  • Excellent communication skills, both written and verbal.
  • Detail-oriented with the ability to manage multiple projects simultaneously.
  • Demonstrated ability to effectively analyze and present data.
  • Experience in using Microsoft Office (Excel, Word, PowerPoint, etc.) and demonstrated ability to learn/adapt to computer-based tracking and data collection tools.

Salary Range: $53,928 - $107,107

Salary Range Disclaimer: The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed.



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