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Job Description
- Req#: 196
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Remote work flexibility, allowing you to work from anywhere
- Collaborative and supportive work environment
- Engage in meaningful work that impacts healthcare policies and procedures
- Involvement in innovative projects related to medical care and coding
What to Expect (Job Responsibilities):
- Review clinical resources and external health plan policies for coverage comparisons
- Conduct timely reviews of CMS-designated codes and determine required code designations
- Collaborate with the Clinical Operations Team to ensure appropriate configuration of codes for billing and auditing
- Maintain expert knowledge of ICD-10 and 11, CPT, and HCPCS codes, providing education as necessary
- Support the Utilization Management team with case reviews and participate in project work as assigned
What is Required (Qualifications):
- Valid, unrestricted RN (registered nurse) Licensure, Compact or Maine Licensed
- Minimum of 3 years of experience working in a health plan
- At least 2 years of policy research and development experience
- Experience in medical necessity reviews within a health plan is highly preferred
- Certification as a coder, or willingness to obtain certification within 6-12 months of hire
How to Stand Out (Preferred Qualifications):
- Experience in coding and compliance within a healthcare setting
- Familiarity with MCG Guidelines and electronic documentation systems, including Salesforce
- Strong analytical skills and attention to detail
- Excellent English communication and writing skills
- Proven ability to work collaboratively in a team-oriented environment
#HealthcareServices #RemoteWork #CareerGrowth #Coding #HealthcarePolicy
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