Post-Pay Clinical Coding
Specialist
We’re
passionate, we’re collaborative and we are growing.
At AArete we live
and breathe to provide the best experience to our clients each and every day.
We are fresh, passionate, have tons of energy, and love what we do – provide
non- labor cost reduction solutions and wow our clients with impeccable
service.
It is an exciting
time to join the AArete team. Our phenomenal growth since 2008 means that the
opportunity exists to expand your skill set and realize your career goals. Come
join the company that was named to Crain’s Chicago “Fast Fifty” List 2018 and
Consulting Magazine’s Best Small Firms to work for 2018.
Position Characteristics:
As Coding Specialist in the AArete Center of
Excellence, you will work closely with client teams to demonstrate in-depth
industry knowledge of medical billing, claims adjudication systems and payment
policies. Ultimately, the Coding Manager is responsible for delivering medical
claims clinical and coding recommendations and supporting the development of
strategies for change.
Primary Responsibilities and Requirements:
·
Effectively act as a cross-functional partner
between AArete’s Center of Data Excellence (CODE), business consulting/client
delivery and data teams to deliver medical claims clinical and coding
recommendations
·
Serve as a subject matter expert in medical billing,
claims adjudication systems and payment policies
·
Review pricing discrepancy claims analytics
generated through CODE’s advanced data analytics methods from a clinical and
medical coding perspective
·
Accept/Reject clinical coding recommendations on claims through
review of corporate policies, regulatory codes, legislative directives,
provider contracts, pre-authorizations, medical records, precedent, practice
standards or other guidelines, including Current Procedural Terminology (CPT)
coding logic/rules
·
Quantify over-/under-paid claims based upon findings
·
Assist with identification and creation of preventative measures
including educational materials, payment holds, new/changed payment policies,
etc.
·
Identify billing issues that can be resolved through recalibration
of the adjudication system or via claims editing
·
Assist in monitoring business processes/systems to assure
integrity and compliance in billing and claims payment
·
Develop internal reports to identify potential
over-/under-payments
·
Review high-dollar claim and post-payment review reports, medical
records and itemized bills to identify issues and recommend changes
·
Serve as a mentor/coach for and manage the day-to-day activities
of Post-Pay Analyst team
·
Develop relationships and work closely with business consulting
and data teams
·
Research regulatory billing and
coding questions
·
Maintain appropriate records,
files, documentation, etc.
Qualifications:
·
Minimum 5 years of medical claims processing and
medical billing experience
·
Knowledge of:
o
Federal (CMS, Medicare) and state
(Medicaid) medical guidelines is required
o
Medical claims billing, coding,
compliance and reimbursement related issues
o
Claims processing, recovery and audit functions
·
CPC required, Payor background preferred
·
Proficiency with Microsoft Suite, including advanced Excel skills,
PowerPoint and Word
·
Previous experience managing a cross functional team
·
Previous
experience working with third-party clients and/or vendors preferred
·
Deep
knowledge and well-rounded understanding of the Healthcare Insurance Payer
Industry, including familiarity with all of the following:
o
The
configuration process (including Claims, Provider and Member) and the
adjudication processes
o
All
lines of business: Medicaid, Medicare,
Duals, Marketplace, Commercial, ASO (Administrative Services Only)
o
All
spend areas: Professional, Outpatient,
Inpatient, Ancillary
·
Knowledge
and understanding of Integrated Delivery System preferred
·
Consulting
experience a plus