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ALTA IT Services is staffing a contract opportunity for a Medical Coding Specialist to support a leading health insurance customer.
The individual acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented.
Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions.
Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity.
Pay $35 / HR
100% Remote
Contract Position
Coding Certification Required
ESSENTIAL FUNCTIONS
Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes.
Provides input on various consequences for different financial and incentive models. Supports to use of alternatives and solutions to maximize quality payments and risk adjustment.
Translates from claim language to services in an episode or capitated payment to articulate inclusions and exclusions in models.
Serves as a technical resource / coding subject matter expert for contract pricing related issues. Conducts business and operational analyses to assure payments are in compliance with contract;
identifies areas for improvement and clarification for better operational efficiency. Provides problem solving expertise on systems issues if a code is not accepted.
Troubleshoots, make recommendations and answer questions on more complex coding and billing issues whether systemic or one-off.
Supports and contributes to the development and refinement of effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity.
May interface directly with provider groups during proactive training events or just in time on complex claims matters. Consults with various teams, including the Practice Transformation Consultants, Medical Policy Analysts and Provider Networks colleagues to interpret coding and documentation language and respond to inquiries from providers.
Keeps up-to-date on coding rules and standards.
Full Time
$63k-80k (estimate)
09/08/2024
11/07/2024
altaits.com
Rockville, MD
200 - 500
The job skills required for Medical Coding Specialist (Remote) include CPT, Billing, Medical Coding, Problem Solving, etc. Having related job skills and expertise will give you an advantage when applying to be a Medical Coding Specialist (Remote). That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Medical Coding Specialist (Remote). Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Medical Coding Specialist (Remote) positions, which can be used as a reference in future career path planning. As a Medical Coding Specialist (Remote), it can be promoted into senior positions as a Medical Records Coding Technician that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Medical Coding Specialist (Remote). You can explore the career advancement for a Medical Coding Specialist (Remote) below and select your interested title to get hiring information.