Coding Specialist - Product System Configuration

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

The Product System Configuration Coding Specialist performs on-going review of all applicable state and federal regulations, as well as internal contracts for alignment with claim adjudication related system configuration. This position is responsible for analyzing and codifying new contracts, Divisions of Financial Responsibilities (DOFRs), and Medi-Cal and Medicare benefits in compliance with AMA and regulatory guidelines. The incumbent may also assist in reviewing and resolving DHCS and CMS encounter rejection data as it related to coding and billing. The Product System Configuration Coding Specialist reviews information related to product reconciliation and assists in IEHP’s efforts to maximize Provider reimbursement and clean-claim standards. The Specialist is also responsible for assisting the Provider Services Department in identifying opportunities for improvement in provider billing practices.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• CalPERS retirement.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

1. Performs ongoing product adjudication review and coding assistance to the team by reviewing all Provider contract compensation amendments and agreements.
2. Conducts research for coding regulations and requirements related to Medi-Cal and Medicare benefits.
3. Analyzes IEHP product and encounter data to identify incomplete or inaccurate configuration and/or incorrectly billed product.
4. Works closely with the Product System Configuration Team, Contracting department, and Product department to provide coding support related to contracts and benefits.
5. Develops and maintains tracking log for Medi-Cal Local Codes and other coding crosswalks.
6. Assist with all regulatory, internal, external or vendor audits as required.
7. Notifies Product System Configuration team of new codes and regulations.
8. Assist in the implementation and maintenance of coding rules to be administered in either McKesson or Meditrac.
9. Codify DOFRs, contracts, and benefits.
10. Demonstrate a commitment to incorporate LEAN principles into daily work.

Education & Requirements 

• Three (3) years of medical coding experience required
• AHIMA or AAPC Coding Certification required
• High School Diploma or GED required

Key Qualifications

• Managed Care Coding experience preferred. Contract coding experience preferred. Encounter or HCC coding experience preferred
• CCS-P or CPC-P preferred
• Knowledge of coding for both Medi-Cal and Medicare services
• Knowledge of coding processes, guidelines and working knowledge of Centers for Medicare & Medicaid Services (CMS) as well as Department of Health Care Services (DHCS)
• Knowledge of CPT, HCPCS, and ICD-10 guidelines are required
• Knowledge in clinical processes and methodology concepts as they relate to all lines of business and Part D plans is preferred
• Knowledge of product processing and/or basic system configuration processes preferred
• Knowledge of Medi-Cal local codes preferred

Start your journey towards a thriving future with IEHP and apply TODAY!

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