Coding Specialst/Health Service ManagerPrimary Location: Blue Bell, PA
Additional Locations: PA-Blue Bell Apply
- Provide policy and coding guidance for initiatives driven by Medical Policy & Program Solutions (MPPS) and Analytics & Behavior Change (ABC)
- Coordinate and conduct post-payment and root cause analysis to validate payment of professional and outpatient facility claims
- Provide medical coding subject matter claim expertise to identify claim overpayments.
- Identify potential waste and abuse by performing audits of claim data and electronic sources.
- Communicate detailed description of the correct claim handling to internal and external constituents
- Professional coding certification is required
- Must be familiar with CMS reimbursement policies, claim editing and industry coding concepts
- Demonstrate basic knowledge of health insurance claim s processing.
- Good investigation skills are a plus
- Excellent verbal and written communication skills
- Comfortable using various databases and computer systems to research and investigate opportunities
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