Medical Coding & Reimbursement Analyst

Are you interested in learning about healthcare professions and the latest healthcare innovations in the KC area? Become part of an organization that is dedicated to making a difference in both your career and community.

Job Description Summary :

The Medical Coding and Reimbursement Analyst researches, coordinates, analyzes, and provides coding expertise in the application of medical and reimbursement contracting, configuration, and benefit mapping. Follows company guidelines and refers issues to appropriate coding, billing, and coverage requirements, as necessary. Acts as a coding subject matter expert resource to internal customers. Able to perform all duties with limited supervision.

Job Description

• Provides analysis and recommendations to Contracting, Provider Payment, Provider Solutions, and Medical Policy team as it relates to coding, bundling, modifiers, clinical edits, benefits, and enforcements
• Participates in provider / client / network meetings, which may include provider education through written communication.
• Reviews complex operative reports and provider information regarding procedures, clinical edits, and fee schedules. Reviews appropriate use of modifiers and codes being submitted by providers to ensure appropriate reimbursement and billing practices.
• Interprets state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information to develop coding recommendations and payment policies.
• Timely and accurate publishing of Payment Policies to Blue KC website
• Evaluates process outcomes, provides recommendations from a code perspective for improvements across multiple lines of business.  
• Educates, investigates and assists internal customers regarding correct procedural coding for benefit, claim and system questions.
• Requests and reviews claims/analytical reports; provide utilization summaries on coding/provider billing practices that may result in an enforcement, benefit, or payment policy change(s).
• Develop proactive and positive working relationships with other departments within Blue KC to successfully drive accurate and timely initiatives related to medical codes, contracting, and reimbursement.
• Communicates effectively with team members, team leadership, and other management.

Desired Qualifications

• Bachelor’s degree from an accredited university or college in Healthcare Administration, Business, Information Systems or a related academic field; OR five (5) years of relevant experience providing the types and levels of knowledge, skills, and abilities required by the job. 
• Certified Coder with AHIMA or AAPC
• Three (3) years of professional experience working with operational and/or analytical processes, preferably within the healthcare industry or managed care payer.
• Must be task oriented and able to meet designated deadlines; productivity standards and able to work independently.
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, operative reports or governmental regulations.
• Ability to write reports, business correspondence and business manuals.
• Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages.
• Ability to define problems, collect data, establish facts and draw valid conclusions.
• Ability to interpret an extensive variety of technical instructions and deal with several abstract and concrete variables.
• Intermediate knowledge of medical claims processing.
• Intermediate level knowledge of Microsoft Office Word, Excel, and Access, or similar PC-based programs.

Preferred Qualifications

• Five (5) years of professional experience working with operational and/or analytic processes, preferably within the healthcare industry or managed care payer.
• Strong understanding of Blue KC core systems (including Facets, Claims Xten, and NetworX)
• Strong understanding of Blue KC claims, reimbursement, and benefit structures.