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This position is responsible to collaborate with Configuration & Claims Operations staff and leaders to enhance operational effectiveness and efficiency by identifying opportunities for automation of existing manual claims processes. Monitor, research and disposition coding and provider appeal queue service forms to resolve CES edit flags and coding pends to ensure appropriate adjudication of claims. Serve as a subject matter expert and provide information and education on coding and coding-related issues. Research and resolution of complex claim and reimbursement issues.
• Identify and analyze coding changes as they relate to accurate claims processing. Minimize rework by ensuring stakeholders are aware of and understand changes and impact on individual lines of business. • Process service forms in coding queues accurately and consistently to maintain expected SLA’s. Serve as a primary resource for coding issues related to claims adjudication. • Assist in the development of training and education materials for providers. Present focused education for providers as needed to minimize claim denials and unnecessary rework. • Participate in and represent coding in internal UCare work groups and committees. Participate in UCare Coding Community of Practice. • Collaborate with key internal departments to manage and resolve complex claim issues, maximize operational effectiveness, support automation and reduce duplication of effort and re-work. • Collaborate with Operations Training to ensure work instructions impacted by coding changes are identified and updated in a timely manner • Assist in the management of the Coding Request Board to resolve coding questions and to complete coding-specific projects • Other projects and duties as assigned.
• Microsoft Word, Excel and PowerPoint skills. Optum Claims Editing Software (CES) – professional and facility. Macess EXP. Amisys and/or HealthRules experience.
• Three years of experience as a certified coder in a healthcare delivery setting, health insurance (payer) setting or Medicare and/or Medicaid setting.
• Impresiv Health is a healthcare consulting and staffing partner specializing in operations management consulting and business optimization services for companies across the healthcare continuum. Started on the belief that a firm’s foundation could be built with a team of thought leaders and proven industry experts, we’ve established a company that delivers quick and efficient results for our clients. • We offer strategic business and technical management consulting services, and a suite of staffing solutions. • Impresiv Health is a services partner with a focus on expediting time-to-value. It’s not just our goal to immediately deliver greater returns on your investment in us as a partner—it’s our reputation.
• Title: Coding Analyst • Duration: 6-8 Weeks + Possible Extension • Travel Requirements: Remote to Start
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