• Job Description

  Req#: 26877
  • Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan.
    
    As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
    
    Candidates residing out of state will need to be able to work Pacific Time Zone hours.
    
    This is a remote position in which we are able to employ in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
  • J OB SUMMARY/PURPOSE
    
    • Provides coding expertise and interpretation to the Claims Department and provides a focus on ICD-10 PCS and diagnosis coding. Provides guidance and expertise in the interpretation of ICD-10 coding as it pertains to the Company's contractual pricing methodologies. Serves as an internal coding expert on issues related to claim qualification for contractual terms.
  • EXPERIENCE/EDUCATION/QUALIFICATIONS
    
    • Bachelor's degree or equivalent experience in a related field required.
    • Certified Coder credential from a nationally recognized coding association required.
    • Experience and/or training in project coordination required.
    • Two (2) years coding experience required.
    • Experience and/or training in the insurance industry, claim workflows/processes, auditing contracts/system quality and navigating health information systems (including FACETS) preferred.
  • KNOWLEDGE/SKILLS/ABILITIES
    
    • Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
    • Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
  • PHYSICAL DEMANDS
    
    • Rarely
      (1 - 10% of the time)
      
      Occasionally
      (11 - 33% of the time)
      
      Frequently
      (34 - 66% of the time)
      
      Continually
      (67 - 100% of the time)
      
      CLIMB - STAIRS
      
      LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
      
      LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
      
      LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
      
      CARRY 1-handed, 0 - 20 pounds
      
      BEND FORWARD at waist
      
      KNEEL (on knees)
      
      STAND
      
      WALK - LEVEL SURFACE
      
      ROTATE TRUNK Standing
      
      REACH - Upward
      
      PUSH (0 - 20 pounds force)
      
      PULL (0 - 20 pounds force)
      
      SIT
      
      CARRY 2-handed, 0 - 20 pounds
      
      ROTATE TRUNK Sitting
      
      REACH - Forward
      
      MANUAL DEXTERITY Hands/wrists
      
      FINGER DEXTERITY
      
      PINCH Fingers
      
      GRASP Hand/Fist

• About the company

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