Coding Analyst I

This position provides general expertise in coding (professional, facility inpatient and outpatient, drug, Durable Medical Equipment (DME), and lab code sets) for highly-regulated, government insurance programs such as Medicare, Medicaid, Affordable Care Act (ACA), Children's Health Insurance Program (CHIP), Federal Employees Health Benefit (FEHB) program, and self-funded plans with unique plan designs, reimbursement, compliance initiatives, regulatory legislation, and billing practices. This analyst reviews claims and monitors provider appeals including sending correspondence to providers.

We are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, and Washington.

About the Role

Schedule: Remote, Monday–Friday, 8am–4pm

Responsibilities

• Reviewing claims (pre-payment) to monitor billing practices and ensure accurate coding and reimbursement based on specific contracts, payment methodologies, and state and federal regulations that vary by geography and lines of business.
• Ensuring review decisions are in line with Employee Retirement Income Security Act (ERISA) standards.
• Logging provider appeals and sending correspondence to providers on submitted appeals.
• Serving as a consultant to various departments within SelectHealth and Intermountain Healthcare, including physicians and facilities. Requires one-on-one physician and/or office engagement, communication, and training.
• Supporting higher-level analysts in their responsibilities and research.
• Effectively managing workload and responsibilities.
• Maintaining subject-matter expertise and educating providers and staff accordingly.
• Ensuring compliance with all coding regulations for all provider specialties (surgical and non-surgical) and coding methodologies (including inpatient (Non-DRG and DRG), outpatient (APC and non-APC), Ambulatory Surgical Centers (ASC), drugs and biologicals, lab and genetics, home health, DME, and any other type of claim received).
• Ensuring compliance with all state and federal regulations, which vary by state and line of business.

Skills

• Medical Billing and Coding
• Claims Processing
• Customer Service
• Critical Thinking
• Documentation
• Time Management
• Communication (Verbal and Written)
• Attention to Detail
• ICD Coding
• Electronic Medical Records (EMR)

Qualifications

Minimum Qualifications

• Associate degree from an accredited institution (education will be verified), or
• Two years of work experience in coding, healthcare, or in a health plan environment.
• Demonstrated intermediate-level experience with Microsoft Office applications.
• Demonstrated excellent written and verbal communication and presentation skills.

Preferred Qualifications

• Bachelor’s Degree from an accredited institution (education will be verified).
• National professional coding certification (e.g., Certified Professional Coder (CPC), Certified Coding Specialist (CCS)). Must be obtained within one year of hire.
• Two years of coding or auditing experience in a professional, facility, or health plan environment.
• Excellent organizational, analytical, and communication skills.
• Demonstrated ability to establish and maintain rapport with co-workers, physicians, and other healthcare providers.
• Demonstrated ability to perform tasks independently and with minimal supervision.
• Demonstrated sound judgment and decision-making skills.
• Experience with Government programs (Medicare, Medicaid, or ACA).

Physical Requirements

• Ongoing need to see and read information, documents, monitors, identify equipment and supplies, and assess customer needs.
• Frequent interactions with providers, colleagues, customers, and members requiring verbal communication, hearing, and understanding spoken information quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision, including frequent computer use for typing and accessing information.
• Ability to remain sitting or standing for long periods to perform work on a computer, telephone, or other equipment.

Location

SelectHealth - Murray, Utah

Pay

$31.01 - $48.84 per hour, dependent upon experience.

Benefits

We provide a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness, encompassing living healthy, happy, secure, connected, and engaged. Learn More About Our Comprehensive Benefits Package Here.