Experience:
5+ years of experience
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Employment Type:
Full time
Posted:
7/17/2017
Job Category:
Health Care Provider
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Healthcare Coding Analyst Principal Job
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Job Description

Description Summary

The incumbent performs complex, specialized analysis of data related to healthcare medical coding and reimbursement policies to collaborate with leadership on business decisions made to reflect changing trends, emerging technologies and other regulatory developed program needs. Serves as a primary contact with business leadership and is accountable for directing projects and coordinating related activities (internal and external) of medical coding and reimbursement projects.

Accountabilities


  1. Facilitates/leads in-depth research and analysis of appeals data and processes to identify trends and emerging issues, and recommend best practices for maximum performance.

  2. Develops/revises reimbursement policies.

  3. Consults with leadership to implement reimbursement policies aligning with changing trends, emerging technologies, and other regulatory developed programs related to healthcare reform.

  4. Develops in conjunction with management a communication plan to support the implementation of Blue Cross coding and reimbursement policies to all lines of business, internal business teams and contracted providers.

  5. Serve on external committees representing Blue Cross. Facilitates issue resolution, planning sessions, and development of implementation steps to bring forward industry changes related to healthcare reform and coding related topics.

  6. Serve as a subject matter expert for corporate initiatives sponsored by Health Management or other divisions/departments (Health Management, Service, Claims) related to coding policy and coding/payment issues.

  7. Responsible for implementation of designated coding projects through the project life cycle including the needs assessment, project initiation, design, development and implementation.

  8. Directs and coordinates activities of cross-departmental committees (e.g. Coding and Reimbursement, RICHIE, NAG, I-team).

  9. Assumes mentor and role model responsibilities across all Provider Finance and Administrative Simplification functions.

  10. May give work direction to lower level Coding Analyst.


Requirements


  • Bachelors Degree and 7 years of relevant health plan or provider office medical coding/claims and/or Business Analyst experience in a healthcare setting applicable to claims/coding, or 11 years of relevant health plan or provider office medical coding/claims and/or Business Analyst experience in a healthcare setting applicable to claims/coding, in lieu of a degree.

  • Three of the following certifications: COC, CPC, CPC-P, CPMA, CCS, CCSP, RHIT, RHIA and RN.

  • Incumbent is expected to enroll in continuing education courses to maintain certification.

  • Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation. 

  • Ability to work independently, self-directed and with team members.

  • Ability to lead team members to resolve complex issues and mentor others on the team.

  • Strong PC skills; Excel, Word, PowerPoint and internet based programs.

  • Demonstrated ability to maintain relationships with internal and external stakeholders, coding experts, and others.

  • Strong knowledge of Medicare rules and regulations and state mandates.


Preferred Requirements


  • Enhanced knowledge of STAR, PAandR, IMS or other internal systems.

  • Additional coding certifications.


FLSA Status

Exempt

About Blue Cross and Blue Shield of Minnesota

Blue Cross develops tools and resources for group purchasers to use with their employees when talking about health care and health improvement. And, we connect with communities and organizations throughout the state to give them the resources to address health issues in their own backyards. Here are a few of the things you can do in this section: Go to BluePrint for Health® Online for information and support for healthy lifestyle improvements Learn about our health improvement programs and our new fitness discounts Find out about our activities and programs for tobacco reduction Learn about our FluStopSM immunization program and what you can do to prevent the flu Stay informed about the health issues and policies affecting you glossary0|0sitemap0|0privacy home | find a plan | find a doctor | health & wellness | about us | blue cross foundation

This company profile was created by AfterCollege and is about Blue Cross and Blue Shield of Minnesota. This page is not endorsed by or affiliated with Blue Cross and Blue Shield of Minnesota. For questions regarding company profiles, please email: care@aftercollege.com.