Highmark Health Payment Integrity Medical Coder in Montgomery, Alabama
Job Description :
This job is responsible for educating providers on proper billing behavior and proper usage of procedure codes and/or modifiers who are identified as outliers in regards to billing Highmark for certain targeted codes; outreach may occur in various formats including written letters, emails, and consultations via telephone. Documents explanations from Provider Outliers to be used in the analysis of billing behavior and cost savings.
Performs outreach via telephone or other means to identified Outlier Providers informing them of their inclusion as an Outlier; meaningfully discusses the Outlier Providers' billing practices and provides education on proper usage of procedure codes and/or modifiers. May also field incoming calls from providers.
Applies medical coding knowledge to determine applicable education for Outlier Provider’s on industry standards and guidelines as well as Payer Reimbursement Policies to enhance and ensure compliance with industry standards.
Documents communications and explanations from Outlier Providers regarding why billing behavior is outside of the norm.
Other duties as assigned or requested.
3 years of medical coding experience
1 year of experience with commercial claims
3 years of experience with the Common Procedure Coding System (HCPCS)
3 years of experience with International Classification of Diseases (ICD-10) coding
Knowledge of the Common Procedure Coding System (HCPCS)
Knowledge of International Classification of Diseases (ICD-10) coding
Understands and applies appropriate Centers for Medicare and Medicaid (CMS) guidelines to coding
Knowledge of anatomy, physiology and medical terminology
Excellent verbal and written communication skills
- High school/Ged
Associates degree in health care or related field
Bachelors degree in health care or related field
LICENSES or CERTIFICATIONS
- Certified Professional Coder (CPC)
Language (Other than English):
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Office- or Remote-based
Teaches / trains others
Travel from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
Pay Range Maximum:
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Req ID: J229270
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