Blue Cross and Blue Shield of Louisiana Medical Coding Configuration Administrator in Baton Rouge, Louisiana
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Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.
Residency in or relocation to Louisiana is preferred for all positions.
This position independently configures, researches, analyzes, implements, maintains and monitors the performance of new and existing payment management systems. Also, responsible for operational functions related to integrated systems, directing short-term and long-term strategic planning to configure and implement institutional coding and payment policies in concert with claim process system capabilities and related software.
NATURE AND SCOPE
This role does not manage people
This role reports to this job: Manager, Medical Coding
Necessary Contacts: To do this job effectively the incumbent has to be in contact with:Medical Directors, departmental management in Payment Integrity, Provider Reimbursement, Medical Management, Network Administration Management, IT Management, Benefits Administration Management, Medical Coding, Project Management Office, Blue Cross Association, other health plans and software vendors in order to successfully configure and implement new and innovative payment programs.
Bachelor's Degree in Accounting, Finance, Business Administration, Economics or Healthcare Administration required
Four years of related experience can be used in lieu of a Bachelor’s degree.
7 years of consultant-level expertise with in-depth research, analysis and application of CPT, HCPCS, and ICD-10-CM coding, billing and reimbursement guidelines for Medicare and private payers required
2 years of extensive experience in the healthcare finance industry including provider reimbursement, provider payments, complex provider contracts, medical coding, clinical editing, fee schedules and institutional reimbursement system implementation required
Requires extensive experience with provider billing practices, American Medical Association coding guidelines, Correct Coding Initiative edits, Physician Specialty guidelines, payor reimbursement programs, claims adjudication processes, and regulatory agency policies (CMS/HCFA).
Experience in solving business, financial and clinical problems with the appropriate technologies and analytic methodologies required
Experience in medical coding and system implementation and testing required
Experience can run concurrently.
Skills and Abilities
Must possess strong analytical skills, supported by equally strong critical thinking skills, and a comprehensive understanding of all aspects of healthcare financing and institutional reimbursement, including industry-wide (private and governmental) payment methodologies.
Must possess excellent oral and written communication skills including the demonstrated ability to present complex financial analysis to Management and facilitate internal strategic operational discussions.
Must have strong project management skills regarding project planning and implementation, including developing scope, goals, work plans, timelines, implementation strategies and measurement processes for assessing progress toward goals and project outcomes, and be able to direct and prioritize multiple projects.
Extensive knowledge of Microsoft Office products including Word, Excel and Power Point. Work experience must demonstrate the ability to work proficiently in a fast-paced demanding environment.
Must be able to travel overnight two to four times a year.
Licenses and Certifications
- Medical coding certification such as CPC or CPHC preferred upon hire but must be attained within 2 years of hire date.
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Provides leadership and operational oversight for a team of reimbursement analyst who support corporate and divisional strategy and goals. Communicates strategy and initiatives to team members supporting achievement of overall company results.
Works closely with the Director, Payment Integrity to continually refine, implement, and manage the payment strategy, focusing on the efficient, compliant and cost effective use and configuration of the related integrated systems, and to align with the corporate and divisional strategies and initiatives.
Responsible for the configuration, implementation, maintenance and documentation of Payment management systems including the clinical editing requirements and the application of medical policy.
Provides written medical coding expert-level responses to internal and external customer requests (provider appeals) for clarification of medical coding issues, clinical editor bundling and filtering, medical coding policy, regulatory agency policy and coding-related reimbursement and medical policy issues, in a prompt and efficient manner to support medical coding-related activities at BCBSLA.
Provides expert testimony on behalf of BCBSLA for medical coding-related issues and serves as the chief medical coding resource for the Medical Director, Medical Coding Committee, Medical Policy Implementation Committee, Financial Investigations, Provider Reimbursement, Provider Audit, Provider Relations, Network Development, I.T., Medical Management, Actuarial and Medical Coding in a prompt and efficient manner to support medical coding related activities at BCBSLA.
Develops and coordinates development of customized code lists, including code updates and crosswalks for BCBSLA mainframe system edits, clinical editor customizations, medical policy implementations, reimbursement program development, medical coding audits, departmental research and projects in a prompt and efficient manner to support medical coding-related activities at BCBSLA.
Makes formal and informal presentations on medical coding issues to internal and external customers of BCBSLA to provide continuing education and to clarify medical coding-related processes at BCBSLA.
Directs the research and resolution of all payment management system coding issues which are identified by various departments as a result of claims processing discrepancies and/or provider disputes. Performs audits and/or works with Payment Integrity to ensure that reimbursement provisions are applied according to contract specifications for new and existing reimbursement programs.
Coordinates efforts with payment policy/editing vendors who support provider payment systems and opportunities/innovations. Assures that contractual requirements are documented and implemented in compliance with company and legal requirements. Lead implementations and updates.
Coordinates efforts with the Medical Coding Department to incorporate quarterly and annual new medical code revisions into reimbursement systems and strategies. Ensures that all new CPT/HCPC codes, etc, are incorporated into all applicable reimbursement programs by the required dates to prevent the related provider claims from paying more than the appropriate, contracted reimbursement. Also ensures that the semi-annual fee updates for new CPT/HCPCS codes are implemented by the established deadlines.
Supports the ongoing development and configuration of the payment management software Ensure that medical coding updates, new enhanced payment algorithms and vendor software updates coordinated timely for both the reimbursement and claim processing systems to ensure the payment of claims is consistent with projected impacts of contract revisions.
Ensures compliance with BCA mandates, DOI mandates, new applicable state and federal laws/regulations, and claims editing rules.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
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In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
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