Coding Specialist - Product System Configuration - San Jose

Overview:

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

The Specialist is also responsible for assisting the Provider Services Department in identifying opportunities for improvement in provider billing practices.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:

Perks

• Competitive salary.
• Hybrid schedule.
• CalPERS retirement.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Key Responsibilities:

1. Performs ongoing product adjudication review and coding assistance to the team by reviewing all Provider contract compensation amendments and agreements.
2. Conducts research for coding regulations and requirements related to Medi-Cal and Medicare benefits.
3. Analyzes IEHP product and encounter data to identify incomplete or inaccurate configuration and/or incorrectly billed product.
4. Works closely with the Product System Configuration Team, Contracting department, and Product department to provide coding support related to contracts and benefits.
5. Develops and maintains tracking log for Medi-Cal Local Codes and other coding crosswalks.
6. Assist with all regulatory, internal, external or vendor audits as required.
7. Notifies Product System Configuration team of new codes and regulations.
8. Assist in the implementation and maintenance of coding rules to be administered in either McKesson or Meditrac.
9. Codify DOFRs, contracts, and benefits.
10. Demonstrate a commitment to incorporate LEAN principles into daily work.

Qualifications:

• Three (3) years of medical coding experience required
• AHIMA or AAPC Coding Certification required
• High School Diploma or GED required

• Managed Care Coding experience preferred. Contract coding experience preferred. Encounter or HCC coding experience preferred
• CCS-P or CPC-P preferred
• Knowledge of coding for both Medi-Cal and Medicare services
• Knowledge of coding processes, guidelines and working knowledge of Centers for Medicare & Medicaid Services (CMS) as well as Department of Health Care Services (DHCS)
• Knowledge of CPT, HCPCS, and ICD-10 guidelines are required
• Knowledge in clinical processes and methodology concepts as they relate to all lines of business and Part D plans is preferred
• Knowledge of product processing and/or basic system configuration processes preferred
• Knowledge of Medi-Cal local codes preferred

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location:

Telecommute

Pay Range: USD $34.41 - USD $44.73 /Hr.