Overview

Are you a certified medical coder that prides themselves on sharing their expertise of coding and regulatory requirements to improve business performance? Do you enjoy recognizing coding patterns and digging into the technical details to test Claims Edit Systems for the most accurate claim outcomes? Are you known for working efficiently and collaboratively to resolve complex claims inquiries?

If you answered “yes” to the above, please consider joining Quartz’s Coding Integrity Unit as a Senior Coding Specialist. This role will work closely with the Code/Claim Edit Software (CES) and business units to maintain and facilitate new code approvals while monitoring and testing for accurate edit status across all lines of business. The Senior Coding Specialist may also serve as a resource for researching and resolving claim pends and resolving inquiries from customer service, providers, and vendors.

Benefits:

• Full-time virtual, telecommuting, work from home environment.
• Exposure to a variety of coding scenarios to broaden experience and knowledge.
• Make a direct impact on members while collaborating and educating multiple stakeholders across the healthcare delivery system on medical coding best practices.
• Base compensation range of $55,000 - $69,000 robust total rewards package.

Responsibilities

• Review, edit and adjudicate claims that are pended and/or assigned in HealthLink based on CES logic/application, regulatory and internal policies.
  • Research and resolve assigned claim pends, review and monitor daily trends.
  • Research and respond to Customer Relationship Management (CRMs) inquires routed for coding expertise.
  • Review and resolve appeals in OnBase or HealthLink by reviewing documentation and making determination.
• Serve as a subject matter expert to advise internal and external parties on correct and compliant coding regulations and requirements for professional and facility coding and billing practices.
  • Edit, adjudicate, and resolve claim pends assigned from CES logic.
  • Monitor and analyze coding patterns to identify potential risks and assist with special projects to address trends, financial impacts, and potential improvements to system and performance and operational capabilities.
• Develop and update claim coding policies, procedures, and supporting documentation.
• Monitor industry standards and regulatory updates, analyzing and communicating impacts or changes that may be required to Quartz operations and lines of business.

Qualifications

• Certification as a professional/facility hospital coder (CPC, COC, RHIT/RHIA, CAA, or CCS).
• Associate degree or equivalent work experience required.
• 3 years of experience in professional and/or facility coding, preferably in the health insurance field.
• Strong working knowledge of professional and facility regulatory guidelines, fee and reimbursement and claims practices (CPT, HCPCS, ICD10, OPPS, IPPS).
• Strong understanding of government-regulated medical payment policies and programs (Medicare, Medicaid, DSNP, SSI, etc.).
• Intermediate proficiency with Microsoft Office is required.
• Epic healthcare software and Optum Claims Edit system knowledge is required.

Applicants have the option to work remote, hybrid or full-time from our Madison, WI or Onalaska, WI office. Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

Quartz offers an excellent benefit and compensation package, opportunity for professional growth and a professional culture built upon the foundations of Respect, Responsibility, Relationships, & Resourcefulness. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.