Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

Internal Use only-Grade 26-30

Level I-II

The Coding Coordinator is responsible for performing audit activities in the areas of data mining, contract compliance, itemized bill reviews and provider outreach/education for all claim types to validate correct claims coding and billing practices.  This role includes the identification and correction of abusive and wasteful billing and coding practices by conducting pre and post-payment coding compliance audits, communicating recommended solutions, and facilitating corrections, recovery of overpayments and provide education to promote correct, accurate and consistent coding and billing practices among providers.  The Coding Coordinator will also have direct responsibility to work with vendors and internal business units coordinating refund recoveries, managing inventory and invoicing in the areas of Credit balance, DRG audits and Secondary claim code edits ensure any corrections, recommendations or issues are resolved to satisfaction. 

REQUIRED QUALIFICATIONS

Required Work Experience

  • 2 years of experience of professional/physician diagnostic and procedural coding, claims administration, claims auditing or related experience required (All Levels)

*Knowledge of medical terminology, ICD-10 CM & PCS, CPT and DRG codes

Required Education

  • High-School Diploma or GED in general field of study (All Levels)

Required Licenses

  • N/A

Required Certifications

  • Certified Coding Certificate (CCS or CPC), or acquired within 24 months of hire (All Levels)
     

PREFERRED QUALIFICATIONS

Preferred Work Experience
  • 4 years of experience of medical coding, claims administration, claims auditing or related experience required (All Levels)
  • 2 years of relevant hospital inpatient coding experience including DRG assignment
  • Experience with coding of all claim types (All Levels)

Preferred Education

  • Associate’s or Bachelor’s Degree in any general field of study. (All Levels)

Preferred Licenses

  • N/A

Preferred Certifications

  • Certified Coding Certificate (CCS or CPC) (All Levels)

ESSENTIAL job functions AND RESPONSIBILITIES

LEVEL 1
  • Through data analysis, identify areas of high risk for coding and billing variances.
  • Collaborate with analyst to define reporting criteria to evaluate shifts in utilization and provider coding patterns.
  • Interprets data, draws conclusions, and reviews findings with all levels within the organization
  • Conducts audits of claims by selecting claims that have been identified as in scope for audit.  Audits claims, medical records and corresponding documentation for appropriate coding.  Applies knowledge of medical coding, diagnostic-related group (DRG) and current coding guidelines.
  • Performs hospital charge audits and itemized bill audits on all high dollar claims and as needed on other questionable charges applicable to outpatient/professional services.
  • Makes complex coding determinations and uses concise reasoning citing the principles and rational used in making the determination.
  • Prepares results/recommendations of the coding audit findings to the providers via claims adjustment notification letters and / or other direct communication.  Articulates clear and concise recommendations that may be challenged by health care providers.
  • Facilitates recovery efforts of claims that were identified as incorrectly billed.
  • Participate on task teams and corporate committees as required, applying coding and analytical skills
  • Quantifies the financial impact for the company and reports findings to management.
  • Acts as resource person for internal and external customers regarding coding and billing practices.
  • Develop, maintain and follow detailed procedures on the process and business rules around audits.
  • Manages ongoing audits and meets timeliness expectations.
  • Develops and maintains collaborative internal relationships.
  • Attend pertinent coding seminars and training, and use other resources as applicable, to maintain current knowledge of rapidly changing coding guidelines.

LEVEL 2

  • Proactively review and identify potential areas of high risk for coding and billing variances.
  • Develop and maintain a thorough understanding of medical coverage and reimbursement guidelines and make independent decisions.
  • Facilitates meetings to discuss areas of difficulty and variance by researching recognized national coding guidelines and medical data to encourage uniformity and consistency of coding practices among providers.
  • Participate on task teams and corporate committees as required, applying coding and analytical skills
  • Manage day to day relationship between business and vendor(s) to ensure seamless and effective delivery of outsources services.
  • Primary communicator/liaison between vendor and business stakeholders to coordinate all communication, answer questions, provide performance metrics updates, manage capacity and demand, and remediate escalations as needed.
  • Partner with business leads to understand evolving service needs and expectations, define business requirements, and work with the vendor to improve capabilities.
  • Establish and coordinate ongoing service level metric/performance reporting to monitor vendor performance and ensure contractual obligations and/or other performance agreements are met.
  • Analyzes information to determine if there are gaps in performance and how to best address through process improvements, training and/or other interventions.
  • Define internal process for handling high severity and stagnant issues/events; escalate and partner with appropriate area for remediation as needed.
  • Ensure adherence to standard procedures for vendor governance, including data access and security.
  • Demonstrate complete ownership and accountability in all roles, process improvements and recommendations.
  • Develop clear and concise recommendations for any potential coding or reimbursement changes including full rationalization and how it might interact with current processes and policies. Present recommendations to the appropriate audience for review and approval.
  • Work closely with other areas of the company to ensure implementation and updates to methodologies are made timely and accurately.
  • Share knowledge of skills, projects, and business needs with peers and less experienced analysts.  Trains new employees as needed

LEAD

  • Plan and lead multiple projects and cross-functional teams from inception to completion. This includes working independently on creating timelines, working with other areas to define deliverables, monitoring progress, implementing the project and resolving/monitoring pre/post-implementation issues.
  • Lead and/or participate on task teams and corporate committees as required, applying analytical skills and actively participating in a team environment to complete projects and accomplish goals.
  • Provides assistance onboarding vender partnerships, business process alignment and operational performance reporting. 
  • Demonstrate a strong business perspective, industry-knowledge, organizational skills and communication skills. Work with and present to all levels of management, including Executives.
  • Independently manage and improve organizational processes.  Evaluate and create new ways to do things while making sure to incorporate input from all key stakeholders.  Keeps abreast of trends or technology that could improve work flow.
  • Demonstrate complete ownership and accountability in all leadership roles, process improvements and recommendations.
  • Identify and explore opportunities for medical and reimbursement policy changes that support claim savings goals, while maintaining focus on appropriate reimbursement levels and relativities.
  • Perform independent research to identify coding and system issues that impact medical coverage guidelines and pricing, presenting recommendations for appropriate corrective measures to management following thorough analysis & independent decision, while actively participating in the resolution.
  • Act as a liaison with health services, other divisions, external vendors and analysts to assure adequate communication and coordination of audit activities, medical and reimbursement policy and coding changes.
  • Support and train other employees in lower levels. Help direct a thorough and efficient review of all audit work being produced in the area.

ALL LEVELS

  • Reports to a supervisor or manager who provides minimal supervision/project management. Develop own work-plans, and discusses timelines, prioritization, and objectives with supervisor or manager.
  • Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned.

REQUIRED COMPETENCIES

Required Job Skills (All Levels)

  • Intermediate skill in use of office equipment, including copiers, fax machines, scanners and telephones
  • Intermediate PC proficiency
  • Intermediate proficiency in spreadsheet and word processing software
  • Basic skill in mathematics
  • Knowledge of medical terminology, ICD-10 CM & PCS, CPT and DRG codes

Required Professional Competencies  (All Levels)

  • Ability to read, analyze, and interpret technical procedures, medical reports, fee schedules and medical coverage guidelines
  • Broad understanding of health insurance terms and concepts
  • General knowledge of the healthcare industry
  • Knowledge of coding principles and code sets including UB92, CPT, HCPCS , ICD 9/10, ADA, and ASA
  • Knowledge of UB92 guidelines.  Knowledge of Medicare rules and regulations
  • Awareness of claims processes and claims processing systems
  • Meticulous attention to detail
  • Ability to deal with ambiguity and make recommendations with less than complete or conflicting information while maintaining appropriate time management
  • Ability to maintain confidentiality and privacy
  • Ability to communicate effectively, both orally and in writing, to peers and direct management
  • Ability to build and maintain productive working relationships with others
  • Skill in prioritizing tasks and working with multiple priorities, sometimes under limited time constraints
  • Ability to summarize coding information to a general audience
  • Proactive about requesting enough information to fully understand and meet the business need
  • Analytical knowledge necessary to generate reports based on available data and then make sound decisions based on reported data
  • Ability to deal with ambiguity and make recommendations with less than complete or conflicting information while maintaining appropriate time management

Required Leadership Experience and Competencies (All Levels)

  • N/A

PREFERRED COMPETENCIES

Preferred Job Skills (All Levels)

  • Advanced skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Knowledge of BCBSAZ corporate structure, functions, and procedures
  • Advanced proficiency in spreadsheet and word processing software
  • In-Depth knowledge of BCBSAZ products, processing systems, files, and computer software

Preferred Professional Competencies  (All Levels)

  • Knowledge of fee schedules and medical coverage guidelines
  • Ability to communicate effectively, both orally and in writing, to all levels in all departments
  • Project management skill needed to create timelines, track deliverables and progress, resolve issues, and communicate project status

Preferred Leadership Experience and Competencies  (All Levels)

  • N/A
     

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank You

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.


Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona



Posted 24 Days Ago

Full time

R898

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