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Indiana University Health

Senior Claims Coding Associate

IU Health Plans
Date Posted
19 July, 2021
Schedule & Shift
Full Time
Day
Requisition Number
311956
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Senior Claims Coding Associate

Job Description

Overview

Manages and coordinates the application of medical claims billing codes. Identifies and monitors accurate coding practices based on CMS, state and federal guidelines. Monitors authorization and service category for coding changes and accuracy. Monitors authorization approval rates and claims auto adjudication. Owns and oversees the review of accurate codes submitted on medical claims including; ICD-10, CPT, HCPCS. Collaborates with internal departments and external vendors to ensure the appropriate usage of codes, conducts high dollar, coverage determinations and reimbursement claims audits. Owns clinical editing appeals resolution and system(s) assessment of annual code and compliance updates. Communicates with internal and external customers regarding coding deficiencies and updates to achieve accurate claims adjudication based on compliant use and submission of valid medical billing codes.


 Bachelor's Degree preferred.
• RHIT, CMC, CRC, CCS, CCS-P, CPC-P or CPC-H preferred.
•2-4 years of experience required.
• Experience in all areas of outpatient/hospital coding through literature reviews and attendance at workshops/in-services is required.
• Working knowledge of governmental annual code updates and determinations required.
• Health Plan and Claims knowledge preferred.
• Knowledge of NCQA, CMS, ACA, IDOI & AAPC coding guidelines preferred.
• Knowledge in the interpretation of clinical data to accepted coding guidelines preferred.
• Experience in trending coding patterns and conducting regular monitoring and assessment of coding assignment decisions to ensure appropriateness of reimbursement preferred.
• Working knowledge of ICD-10-CM; CPT; DRG, APC, with expertise in ICD-10-CM coding principles and reimbursement implications as well as modifier rules preferred.
• Working knowledge of overseeing complex audits and ability to troubleshoot, using electronic medical records, audit issues with providers and internal departments preferred.

 

Safeguarding our patients and each other is an important part of how we deliver the best care possible to the communities we serve. As a condition of employment, IU Health requires all new hires to receive various vaccinations, including the influenza and COVID-19 vaccines, barring an approved exemption. New hires will also be provided the option to submit proof of previous vaccination. The COVID-19 vaccine is not required to begin employment; however, all team members need to be fully vaccinated by September 1, 2021.

We are an equal opportunity employer and value diversity and inclusion at IU Health. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

Qualifications for the Senior Claims Coding Associate Role

Overview

Manages and coordinates the application of medical claims billing codes. Identifies and monitors accurate coding practices based on CMS, state and federal guidelines. Monitors authorization and service category for coding changes and accuracy. Monitors authorization approval rates and claims auto adjudication. Owns and oversees the review of accurate codes submitted on medical claims including; ICD-10, CPT, HCPCS. Collaborates with internal departments and external vendors to ensure the appropriate usage of codes, conducts high dollar, coverage determinations and reimbursement claims audits. Owns clinical editing appeals resolution and system(s) assessment of annual code and compliance updates. Communicates with internal and external customers regarding coding deficiencies and updates to achieve accurate claims adjudication based on compliant use and submission of valid medical billing codes.


  • qualifications__list
     Bachelor's Degree preferred.
  •  RHIT, CMC, CRC, CCS, CCS-P, CPC-P or CPC-H preferred.
  • 2-4 years of experience required.
  •  Experience in all areas of outpatient/hospital coding through literature reviews and attendance at workshops/in-services is required.
  •  Working knowledge of governmental annual code updates and determinations required.
  •  Health Plan and Claims knowledge preferred.
  •  Knowledge of NCQA, CMS, ACA, IDOI & AAPC coding guidelines preferred.
  •  Knowledge in the interpretation of clinical data to accepted coding guidelines preferred.
  •  Experience in trending coding patterns and conducting regular monitoring and assessment of coding assignment decisions to ensure appropriateness of reimbursement preferred.
  •  Working knowledge of ICD-10-CM; CPT; DRG, APC, with expertise in ICD-10-CM coding principles and reimbursement implications as well as modifier rules preferred.
  •  Working knowledge of overseeing complex audits and ability to troubleshoot, using electronic medical records, audit issues with providers and internal departments preferred.

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Indiana University Health is Indiana’s most comprehensive health system, with 16 hospitals and more than 34,000 team members serving Hoosiers across the state. Our partnership with the Indiana University School of Medicine gives our team members access to the very latest science and the very best training, advancing care for all. We’re looking for team members who share the things that matter most to us. People who are inspired by challenging and meaningful work for the good of every patient. People who are compassionate and serve with a purpose. People who aspire to excellence every day. People who are always ready to apply themselves.

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