3 - 5 years of experience required
This position is responsible for researching and providing written processes for correct coding; the Compliance coding Specialist will train IHA staff and physicians on coding standards and procedures, including the transition to ICD10 requirements.
This person would work closely with IHA's Compliance Team to maintain coding standards and procedures in alignment with regulatory and payer requirements.
Essential skills include understanding federal, state, and insurance company regulations and contract requirements affecting compliance in a healthcare setting;
compliance plan and auditing standards.
Ability to analyze RBRVU data in correlation to IHA's fee schedule; a
bility to effectively navigate through NextGen and other relevant practice management systems specifically with respect to understanding billing and office procedures.
Substantial knowledge of managed care and insurance practices,
insurance claims and billing process, fee schedules and pricing.
Moderate to high level of proficiency using office computer systems and applications and e-mail; u
nderstanding and/or hands on experience with office processes, procedures and workflows;
possess knowledge of adult learning styles in order to facilitate development of effective educational sessions, with demonstrated ability to employ multiple teaching methods to provide effective education to different style learners.
Ability to communicate effectively and professionally verbally, in writing, and during group presentation; a
bility to coordinate activities and work independently to complete projects requiring highly complex analysis.
Maintain working knowledge of EPM and EHR systems, Microsoft Office Software, office responsibilities and billing processes.
1. Bachelor's Degree or equivalent combination of education and experience.
2. 3 years of experience coding, reimbursement analysis, insurance issue resolution and medical record auditing.
3. Previous experience with primary care and multi-specialty care preferred, other relevant experience would include provider relations or customer service representative work with a health care insurance organization.
4. Claims payment and data management experience is highly desirable.
5. Ability to attain Certified Professional Coder designation is highly desirable.