Benefits Coding Analyst

Sentara Health is looking to hire a Remote Benefits Coding Analyst.

This position is remote however, candidates must be able to commute to our Richmond location.

The Benefits Coding Analyst – Certified Professional Coder maintains the integrity of the plan benefits for each program and is responsible for developing an extensive expertise of all plan benefits. The Benefits Coding Analyst will work closely with multiple teams across the Health Plan, including but not limited to Claims, Compliance, Program, IT, and Health Services/Medical Management to ensure benefits are compliant with state and Federal guidelines, as well as aligned with Program benefit offerings. This position is responsible for synthesizing the input from multiple stakeholders to inform significant business decisions regarding benefit implementation as well as coordinating and maintaining benefit design documentation for the organization. The Benefits Coding Analyst will research, code, and assist with the development of benefit and utilization review policies and criteria for emerging treatments, technology, medications, and health plan services. This role will assist in researching code updates, authorization requests, and claim questions, updating business rules and benefit repositories as appropriate.

Education:

• Associate Degree in Healthcare (preferred)

Certification:

• Certified Professional Coder certification (CPC) (required)
• Certified Inpatient Coder (CIC) (preferred)
• Medical Assistant Certification (preferred)

Note: CIC is required for advancement to Level 2 and Level 3
 

Experience:

• 2 years of medical coding or billing experience specifically within reimbursement, coding, claims processing, claims auditing and /or various payment methodologies (required)
• Experience in both established benefit coding environments as well as experience in determination of coding requirements for new benefits (preferred)
• Experience resolving billing and claims issues related to benefit to code assignment.
•Thorough knowledge of anatomy and medical terminology
• Expertise with NCCI (National Correct Coding Initiative) guidelines
• Knowledge or direct experience processing Government program or commercial health claims for an MCO
• Experience with ICD-10 CM, CPT, HCPCS, QNXT.

Keywords: Talroo-Allied Health, Healthcare, Coding, CPC, CIC, Billing, Claims, Auditing, ICD-10 CM, CPT, HCPCS, QNXT and Revenue coding in a managed care setting