Claims Monitoring Coding Specialist

Blue Cross and Blue Shield of Vermont is looking for a Medical Coding Specialist to join our Claims Monitoring team within our Payment Integrity department. Our company culture is built on an unwavering focus on our members and giving them the best service possible. We offer a balanced, flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision, 401k, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development.

REMOTE WORK: Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week.

Coding Specialist Responsibilities:

• Data mines and analyzes medical coding to aid in identifying overpayments, consistencies, and other trends in claims data.
• Research requests using multiple systems (including: Sales Force, Jira, NPS) to provide all available details to reviewer
• Use SalesForce, Jira, and NASCO claim systems, to perform functions such as initial claim review, outcome reporting, and distribution based on triage
• Correspond with providers regarding decisions about requested services and obtain medical records when necessary
• Review and respond to issues and questions from internal and external customers, both verbally and in writing
• Work collaboratively with other departments to obtain additional information to resolve inquiries

Coding Specialist Qualifications:

• Bachelor’s degree, or equivalent combination of education and experience, with a minimum of 3 years’ experience in medical coding; In-depth knowledge of CPT, ICD-9, ICD-10, HCPCS, DRG diagnosis and procedure coding
• Formal coding certification (eg: CPC, AAPC) is a must
• Experience with both professional and facility claims coding and in APC, HIPPS, or RUG coding and validation

Coding Specialist Benefits:

• Health insurance (including vision)
• Dental coverage (free to employees)
• Wellness Program
• 401(k) with employer match automatic employer contribution
• Life Insurance
• Disability Insurance
• Combined time off (CTO) – 20 days per year 10 paid holidays
• Tuition Reimbursement
• Student Loan Repayment
• Dependent Caregiver Benefits