About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans. The Company served approximately 2.2 million members nationwide as of September 30, 2010. For more information about WellCare, please visit the Company�s website at www.wellcare.com.
Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the Company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national PDP provider and the largest Medicaid plan in Georgia. Today, WellCare has approximately 3,500 associates and 2.2 million members nationwide.
The Medical Coding Specialist reviews member medical records from providers to verify and ensure accurate claim diagnosis coding in compliance with CMS and State-specific guidelines.
Reviews medical records to ensure appropriateness and accuracy of ICD-9 coding
Identifies coding errors and recommends correct coding of medical claims
Serves as liaison between the claims payment department and the provider
Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9) and codes in accordance with regulatory agencies and hospital/outpatient specific guidelines
May be required to travel to Providers to conduct on-site audits and training for inpatient coding issues.
25% travel required (some overnight) for outpatient coding audits for Finance only. Local travel for Health Services
All other duties requested by Manager/Director
High School Diploma. Associate's Degree a plus
2-4 years medical coding experience in physician based coding
Both inpatient and outpatient experience required. Inpatient only for HS
Expert knowledge of medical terminology, abbreviations, and disease, illness, and injury processes
CPC, CCS-P. CCS also considered a plus for Health Services
Communication and Numeric Skills:
Must be able to effectively communicate verbally and in writing complex coding issues
Must be able to effectively communicate verbally and in writing in order to manage projects and tasks as well as to promote teamwork, communication, and knowledge transfer.
Must be able to communicate technical solutions to management for review and approval both verbally and in writing.
Must be able to understand and follow verbal instructions and written polices and procedures to ensure adherence to standards and to instructions from management.
Must be able to read, write, speak, and understand English in order to communicate with customers, staff, vendors, and management.
Knowledge of electronic medical records/billing systems
Must have working knowledge of Excel and spreadsheets and Access
Must be able to use Word to communicate effectively and professionally
Must be proficient with Outlook to use the e-mail, calendar, and task features and for e-mail support
Up to 25% travel and overnight travel is required for outpatient coder for Finance only. Local travel for Health Services
A valid driver's license and the ability to drive to remote sites for support as necessary
Is a relocation package available?
WellCare - 3 years ago
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