Description
QUALIFICATIONS:
Bachelor’s degree in Nursing or RN Certification required. Must be a licensed RN in Louisiana.
Must have three years experience as an RN. Experience in multi-speciality setting preferred.
A thorough knowledge of disease processes and medical and surgical procedures is required.
Medical coding background (ICD9 and CPT4) preferred.
Certified Professional Coder (CPC) preferred.
Good research, audit skills and prior background in audit-related functions is preferred.
Must have excellent oral and written communication skills.
Experience with provider billing practices, American Medical Association coding guidelines, Correct Coding Initiative edits, Physician Specialty guidelines, BCBSLA reimbursement programs, provider agreements, claims adjudication processes, and regulatory agency policies (CMS/HCFA, DOI, State regulations) preferred.
Good analytical, organizational, and interpersonal skills.
Must be able to travel overnight, up to one week, in personal vehicle.
Working knowledge of relevant software (Word, Excel) and ability to learn new applications is necessary.
ACCOUNTABILITIES:
Audit providers to ensure correct medical coding and billing practices, enforce reimbursement and member agreement compliance, and recover incorrect payments.
Resolve CPT or ICD9 reimbursement and medical coding appeals and inquiries for internal and external requests to clarify medical coding issues, clinical editor bundling, medical coding policy, coding-related reimbursement and medical policy issues.
Identify provider reimbursement related problems, including medical coding and processing issues. Research, audit, and make recommendation for corrective action by providers or BCBSLA.
Maintain a thorough understanding of medical coding guidelines, provider operations and billing systems, contract benefits, claims procedures, provider contracts and reimbursement agreements.
Engages in provider relations activities which assist in provider and subscriber problem resolution and maintain a positive Plan image.
Research and identify excessive medical coding and charge patterns, and over utilization of services to support provider contracting and reimbursement negotiation efforts.
This position reports to the Director of Provider Audit/Medical Coding.
Grade: 13. Minimum salary: $4,077.84/month.
Details:
Job Id:
1584
Annual Salary:
Position Type:
Education Level:
No Selection
Experience Level:
No selection
Posted:
8/11/2009 9:21:26 PM
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