Certified Medical Coder (Health Insurance Experience)
Axiom Systems - United States

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Overview:

AXIOM Systems, Inc. is the premier healthcare IT and business solutions provider specializing in support for the system integration, implementation, enterprise reporting, HIPAA and EDI needs of healthcare organizations. AXIOM is unique in its ability to develop and implement practical, effective solutions based on its deep knowledge of the healthcare industry.

To support its clients AXIOM is looking to fill a Certified ICD10-CM/PCS Medical Coder position with experience in HEALTH PLANS, HEALTH INSURANCE , or PAYER organizations .

Please read the qualifications carefully:

A candidate will only be considered IF you have worked directly for a health insurance company (ie: Blue Cross Blue Shield, Aetna and etc.) You must have worked for a payer. If you only have experience working for a provider, clinic or hospital organization, please do not submit your resume.

If you have coding experience with a health insurance company, insurance carrier, third-party administrator, health plan sponsor, or any other form of payer, please submit your resume for immediate consideration.

Relocation is not required, though weekly travel to Virginia Beach, VA is.

Must be able to work on site in Virginia Beach, VA weekly.

Responsibilities:

Provide expertise in maintenance of rules, policies, procedures and processes focused on ensuring organizational compliance with industry standard coding practices. Interpret and apply National Uniform Billing Compliance rules, guidelines, laws and industry trends to support accurate provider reimbursement, system configuration, and ongoing provider
education. Recommend clinical classification and reimbursement guidelines and
standards.

PRIMARY RESPONSIBILITIES:

1. Reviews claims routed to the department for billing/coding compliance issues

2. Provide coding review resources developed by the medical coding team. Perform quality assurance functions and rate sheet reviews for code recommendations.

3. Creates and maintains code sets used for configuration in benefits & pricing and other sub-systems. Changes to approved code sets are updated accordingly.

4. Assists in the resolution of claims payment issues identified as needed.

5. Interfaces with operational department management on industry standards and National Uniform Billing Compliance issues.

6. Assists in provider, provider office staff and Amerigroup staff education process related to medical code assignments, national coding initiatives, industry standards and required documentation.

7. Perform other duties as assigned.

Qualifications:

Years and Type of Experience

Required :
  • Coding experience in a payer , health insurance, or Medicaid environment is a requirement
  • Minimum of 6 years coding (ICD-9, CPT-4, E&M, HCPCS, DRG and Revenue) experience with a minimum of 2 years experience in claims, clinical or managed care environment.
Certifications or Licensures

Required:
  • AAPC (CPC) or AHIMA (CC) coding. Must maintain
    licensure, i.e. completion of annual continuing professional education
    requirements
  • MUST BE A CERTIFIED CODER
Functional Competencies:
  • Intermediate to advanced level MS Office skills.
  • Advanced understanding of medical terminology, body systems/anatomy, physiology and concepts of disease.
  • Ability to analyze, interpret and summarize contracts, regulations, policies and procedures, reports and legal documents.
  • Ability to respond to questions/concerns from internal/external customers and regulatory agencies and present company position in understandable and unambiguous manner.
  • Prior claims processing system knowledge preferred.
  • Ability to apply creative/breakthrough methodologies and thinking to the tasks
  • Strong communication skills, both written and verbal; articulate, persuasive & influential; systematic and timely

Axiom Systems - 23 months ago - save job
About this company
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AXIOM Systems was founded in 1996 with the idea that a dedicated group of Healthcare technology professionals could thrive by providing...