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Corporate Functions & Operations WellCare - Claims Careers

Claims Coding Rules - Supervisor Job

Full Job Title: Supv, Claims Coding Rules

Job Number: 1705400

Location: Tampa, FL

Date Posted: 11-17-2017

Manages claims coding rule process. Evaluates claims coding rule change request from clinical, financial, and claims operations perspectives and make recommendations. Maintains and configures claims coding rule software. Oversees and trains coding staff.
Location: Tampa FL Idlewild Office
Type: Exempt Salary
Report to: Manager, Claims Coding
Essential Functions:
  • Manages claims coding rule initiatives including the development of detail work plans.
  • Receives and logs requests of changes and appeals to committees ruling.
  • Maintains a library of all the existing and retired rules, the source of the rule and the implementation/retire date of the rule (by Market and by Line of Business)
  • Documents supporting authority for each claims coding rules by Market and by Line of Business (Master Grid)
  • Participate in cross-functional teams to address key claims coding rule issues facing the organization.
  • Administers communication to Markets and collect feedback
  • Evaluates change proposal from Clinical perspective, Financial perspective, and Claims operational perspectives; Prepare analysis of claims coding rule changes.
  • Seeks professional feedback from Health Services, Finance, and Claims on claims coding rule changes
  • Identifies coding error (e.g., upcoding, bundling/unbundling) and recommend correct coding of medical claims
  • Researches CMS/State laws and AMA guidance
  • Presents change proposal to committee
  • Communicates effectively to markets
  • Develops relationship with claims coding rule software vendors
  • Provides mentoring and guidance to Specialists
  • Train less experienced staff
  • Support claims and/or appeal & grievances team
  • Support claims configuration team
  • Discuss coding issues with finance and vendors to optimize payment
  • Accurately code records for appropriate reimbursement
  • Perform other duties as assigned.
Education: Associate's degree or relevant industry experience.
Experience: 3-5 year's medical coding experience with a hospital or payer organization. Experience working with health insurance claims payment system.
Advance user of IntelliClaim
Experience with Fair Isaac Payment Optimizer preferred
Licenses/Certifications: CCS, RHIA, or RHIT
Technical Skills/Requirements: Billing expertise in UB92, 1500 and other healthcare services
Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations
Knowledge of 3M Encoder a plus

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Last Updated On: 12/9/2015