Medical Coding Specialist

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As a Fortune 50 company, we hire the best employees to serve our customers, making us a leader in the insurance and financial services industry. State Farm embraces diversity and inclusion to ensure a workforce that is engaged, builds on the strengths and talents of all associates, and creates a Good Neighbor culture.

We offer competitive benefits and pay with the potential for an annual financial award based on both individual and enterprise performance. Our employees have an opportunity to participate in volunteer events within the community and engage in a learning culture. We offer programs to assist with tuition reimbursement, professional designations, employee development, wellness initiatives, and more!

Visit our Careers page for more information on our benefits, locations and the process of joining the State Farm team!

Individual responsibilities may vary by role. 

• Works within Medical Resources to provide guidance on medical coding and billing standards to assist in the processing of medical claims. 
• Utilizes knowledge of basic medical/anatomical terminology and advanced medical coding practices and standards to assist claim operations with the automated medical bill review process including obtaining appropriate CPT codes and some manual pricing for bills. 
• Coordinates with peers and leadership within Medical Resources and across Claim segments to support bill review workflow.
• Reviews, analyzes and revised medical bills, updates details within an automated medical review system as well as assists other with revising and analyzing bills.

• Prior experience in medical coding from working in a hospital, facility billing department or insurance company desirable
• Current Certified Professional Coding Certification (CPC), Certified Outpatient Coder (COC) desired
• Completion of applicable training and continuing educational courses as needed.
• Working knowledge of Medicare fees on Part A (DRG and APC pricing) and Part B pricing methodologies, Medicare data files, automated medical review system, regulatory requirement and  classification systems, including CPT, ICD-10 and HCPCS; coding rules and guidelines.
• Continuous outside study in developments in the industry billing and coding standards, applicable state for fee schedule regulations and local billing trends for application within Medical Resources.
• Working knowledge and application of National Correct Coding Initiatives (NCCI) edits.
• This is not a claims handling role nor is it a practicing medical professional. Claim decisions will not be made by incumbents in this role. They are a resource to assist claim handlers with understanding medical information presented in the claim.

The typical work week is focused on responding to coding and billing inquiries from Claim Handlers and Claims management which are received by phone call or through task received from system generated task assignments. The questions received from our claims business partners are related to coding and billing standards to assist in the processing of facility and provider medical bills.

The Medical Coding Specialist will be charged with staying abreast of any updates to billing and coding standards and will share that information with our operation. As needed the Medical Coding Specialist may collaborate with other roles within Medical Resources to facilitate training sessions on coding and billing. The Medical Coding Specialist may be involved in some quality assurance reviews and will provide feedback to leadership as needed. Will work in conjunction with other roles with Medical Resources to identifying medical bill review application issues that may lead to the development of solutions to improve work processes and efficiencies.

As a part of increasing business acumen and staying abreast to the ever evolving changes in the billing and coding and medical care industry, continuing education is very important to the organization. Continuous outside study and development in the field of medical billing and coding expected.

A great perk about working within the Medical Resources Operation is the variety of specialties, experiences and wealth of knowledge that each team member brings. Our teams are comprised of RN’S, LPN’S, Physical Therapist, Radiology Tech’s, Chiropractors, and MD’s. The variety of specialties creates an environment of collaboration between team members which provides clearer insight when responding to billing and coding questions.

Hours Of Operation: 7AM-4:30PM (CT)

Training Details:  8-12 weeks of training (Hours during training: 8AM-4:30PM). 

Training will focus on learning the following:  insurance/claim terminology, claim platform, medical bill review software and medical billing and coding.

We Are Looking for Candidates With

• Strong Work Ethic
• Current Certified Professional Coding Certification (CPC), Certified Outpatient Coder (COC) desired
• Experience working within a Hospital, facility billing department or insurance company desired.
• Strong interpersonal, communication and critical thinking skills.
• Able to facilitate training within small groups and/or larger group settings.
• Tech savvy
• Willingness to work flexible work shifts, irregular hours, including weekends based on workload and job requirements as operation dictates.

Additional Details:

• Certified Professional Coding Experience preferred
• Developing and Delivery training experience preferred
• Strong Communication Skills

• Continuous outside study and development in the field of medical billing and coding expected.
• Job may require travel overnight via commercial transportation or driving motor vehicles to any office locations where the Company does business, or other locations to conduct/attend training, conferences, meetings, and/or seminars
• Incumbent must be willing to work flexible work shifts as operation dictates
• Trains, coaches and/or mentors others in medical bill review process including addressing coding issues to obtain CPT codes, manual pricing, or other details for medical bill review process.
• Assists other Medical Resources personnel in identifying and communicating trends that may warrant training or educational support.
• In conjunction with others in Medical Resources, may develop job aids and other educational material based on identified needs.
• May provide quality assurance oversight.

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