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Medical Policy and Coding Consultant Job in Harrisburg, Pennsylvania

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Job Title: Medical Policy and Coding Consultant

Employer:Capital Blue Cross
Skills:coding,medical policy research,CPT,CDT. HCPCS,ICD-10,revenue codes
Required Certifications:CPC and/or COC
Required Experience:3 to 4 years
Location:2500 Elmerton Avenue Harrisburg 17177, PA, US
Date Posted:10/31/2019

Capital BlueCross is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. As a partner in the community’s health for 80 years, we offer health insurance products, services, and innovative technology solutions that provide peace of mind to consumers and promote health and wellness for our customers.

More than a health insurer, the company delivers innovative solutions through a family of diversified businesses that is creating a healthier future and lowering health care costs. Among these solutions are patient-focused care models, leading-edge data analytics, and digital health technologies.

Capital BlueCross has an exciting opportunity for a Medical Policy & Coding Consultant to join our award winning organization.  Proud to be named a Best Places to work in PA, Harrisburg Magazine’s Simply the Best, Highest Member Satisfaction J.D. Power Award, and since 2014, Capital BlueCross has scored higher than all health insurance providers publicly measured in the American Customer Satisfaction Index (ACSI).  Please click the following link to see additional awards and information regarding our company http://capbluecross.mediaroom.com/.

Each member of our organization--now spanning five generations, knows that there is a person-- a neighbor, a friend, a family member--relying on us to ensure an effortless experience as we deliver on our promises.  Capital BlueCross offers employees excellent pay, bonus opportunities, benefits, health and wellness incentives, opportunities for career advancement and community involvement, and work-life balance.  In return, every member of our workforce plays an important part in something much bigger: working together and making a difference every day to improve the health and well-being of our members and the communities in which they live. If you are looking to make a difference every day in the community for which we live and have the skills and qualifications listed below, we invite you to take the first step in making that difference.

************************************************************************************************************************Position Summary:

This position is responsible for serving on the Medical Policy and Coding team to maintain medical policy and corporate coding structures. This typically involves:

·     Conducting medical policy research to create, revise, or archive assigned medical policy                                                  

·     Reviewing Federal/State mandates to ensure assigned medical policy is compliant with regulatory requirements

·     Writing medical policy as assigned and applying procedure and diagnosis codes

·     Supporting vendor programs, new code, single source, and special projects and coding initiatives

·     Monitoring for trends/patterns/changes in medical care

·     Completing comparisons of local/competitor plans

·     Generating and analyzing claim reports to provide impact assessments, mitigate stakeholder concerns, and and ensure payment is correct

·     Participating in Clinical Advisory Committee meetings, Pre-Configuration meetings, Utilization Management meetings, etc.

JOB REQUIREMENTS include Current and non-restricted clinical licensure within the Commonwealth of PA, and 3-5 years of clinical experience, as well as at least 3-5 years of experience with medical policy, coding, and diagnosis coding (ICD10, CPT, CDT, HCPCs, revenue codes, etc.). Also required is a solid working knowledge of government regulatory and accrediting and related policies and regulations (PPACA, CMS, FEP, NCQA, URAC, DOH, Medical Assistance, etc.), and demonstrated proficiency in the use of Microsoft Office Suite (Outlook Word, Excel, Power Point, Access, Share Point).

Medical Coding certification (CPC and/or COC) is preferred, and required within one (1) year of hire. This position also requires exceptional organizational skills, attention to detail, and ability to work effectively with minimal supervision. Additionally, the ability to perform basic arithmetic, percentage and statistical calculations is essential.

************************************************************************************************************************Our innovative Capital Blue Health and Wellness Centers located in Enola and Center Valley provide in-person service and inspiration to help people reach their health goals. Each one is open to the public and includes a fitness studio, Healthy You Café and on-site care guides skilled in multiple areas, including nutrition and biometrics screening. Capital BlueCross employees can take advantage of the many services offered at Capital Blue at little to no cost.

Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law. Engage with us on LinkedIn, Twitter, Facebook or Instagram.



To apply, visit our web site, CapBlueCross.com/careers

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