The 1199SEIU Benefit & Pension Funds provide comprehensive health, pension, and quality of life benefits to unionized workers represented by 1199SEIU United Healthcare Workers East. We are among the largest labor-management funds in the nation, covering 400,000 members and their families.
If you’re ready for the brightest career future, join us in this excellent opportunity to showcase your talents. We are currently seeking an experienced Coding Coordinator for our Care Management department.
Responsibilities
• Conduct coding and clinical policy research, analysis and offer recommendations to resolve issues
• Apply coding knowledge to clinical and reimbursement policies, procedures, laws and regulations
• Integrate medical coding and reimbursement rules as part of retrospective review process to standardize Funds coding and billing processes
• Link proper diagnosis codes with appropriate CPT codes for billing purposes
• Review and assign accurate medical codes for diagnosis, procedure, service and provider specialty standards
• Utilize QNXT Claims Check Edit, McKesson guidelines and Correct Coding Initiative for accurate assignment of codes
• Translate ICD 9 to ICD 10 codes; troubleshoot coding issues for staff and direct inquiries to other departments as needed
• Responsible for assisting and managing challenging coding inquiries and interact with physician advisors and other departments to efficiently troubleshoot and resolve issues
• Ability to prioritize and assist with special project requests and perform complex research and analysis of clinical coding issues
• Identify trends and variations and communicate with management
• Submit weekly productivity and status reports; maintain excel database to monitor, measure, report and manage work load
• Perform additional duties and projects as assigned by management
Qualifications
• High School Diploma or GED required; College degree preferred in healthcare, business or related field
• Minimum two (2) years experience with health plan/managed care organizations/providers in case management and/or utilization management department as a certified coder required
• Intermediate skill level in Microsoft Word and Excel required
• Must have current certification in American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC), American Health Information Management Association (AHIMA), or Certified Coding Specialist (CCS)
• Knowledge of Coding principles, CMS regulations and protocols, third party coding and billing requirements
• Proficient in medical terminology (CPT, HCPCS, ICD-9 and ICD 10 coding)
• Comprehensive knowledge of eligibility and benefits with commercial carriers and Content Management System (CMS)
• Medical claims processing system experience desired with understanding of utilization review and case management and its processes
• Critical thinking and analytical skills with effective troubleshooting and problem-solving abilities
• Ability to work in a fast paced environment and able to utilize computer applications simultaneously
We offer a competitive salary, an excellent fully employer-paid comprehensive benefits package and talented professional colleagues.