Blue Cross and Blue Shield of Louisiana Medical Management Inpatient Coding Analyst in Monroe, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
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.
The Medical Management Inpatient (IP) Coding Analyst will assist in all areas of the Medical Management Department Inpatient division to obtain the common goal of improving the Quality of Care within the Blue Cross Blue Shield of Louisiana member group. They will work directly with the Medical Management Inpatient nurses and Medical Directors to ensure DRGs are accurately represented on claims for inpatient admissions.
NATURE AND SCOPE
This role does not manage people
This role reports to this job: Departmental Leadership
Necessary Contacts: Claims, Medical Directors, Providers, Appeals, and Member Services
Bachelor’s degree RHIA or RHIT Degree is required.
Four years of related experience can be used in lieu of a Bachelor’s degree
Five years of acute care hospital coding experience is required.
Previous experience in Utilization Review, case management, and/or medical underwriting is preferred.
Two years of experience as a Clinical Documentation Specialist is preferred.
Skills and Abilities
Must have knowledge of National recognized screening criteria. (Interqual or MCG).
Must have excellent computer skills.
Must have knowledge and experience with Electronic Health Records.
Ability to work with supervision and follow established policies and procedures.
Exceptional interpersonal, verbal, and written communication skills.
Exceptional Customer service-oriented attitude/behavior.
Must have previous inpatient workflow experience.
Knowledge of Fitness, QNXT, Acuity, Onbase, Vnet, Faxcom and other coding software.
Licenses and Certifications
- Nationally recognized Inpatient Coding Credentials is preferred.
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Assists the RNs with clinical data collection from providers on acute Observation, Inpatient, SNF, LTAC and Rehab admission requests as necessary.
DRG Review Process: Performs clinical coding reviews, clinical report requests and DRG claims. Prepares DRG profiles from facility submitted claims for medical director review, edit and complete all DRG’s that have been completed by the medical director which requires entering their decision into the Acuity authorizations.
Responsible for daily preparation of DRG reviews downloaded through the Encoder Pro system for Medical Director and IP Nurse review.
Reassigns and sequences diagnostic and procedural codes using universally recognized coding system as appropriate, and compile and analyze statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate payment.
Requests any additional clinical information from the facilities via fax and/or phone for those DRG reviews that the medical director is asking for further review.
Scans and attaches all inpatient case DRG Review profile sheets to the appropriate Acuity authorization once the DRG Review is completed.
Logs into the Inpatient phone que as needed.
Responsible for overseeing and serving as a back-up to the Administrative Assistants who are primarily responsible for the Inpatient Medicare, Commercial, and Metal Plan Bed-days monthly count.
Responsible for requesting of discharge summaries and/or medication reconciliations for all lines of business when the admin assistant is assisting the IP nurse completing the authorizations.
Creates appropriate DRG Change Explanation letter for the selective providers and route to the providers accordingly (fax and/or mail).
Assists the RNs with completion of IP admission cases in a timely manner which involves verification of coding of procedures performed, diagnoses codes, and estimating a DRG to those cases if applicable per facility and contract.
Provides education to Medical Management staff on coding and coding rules.
Will serve as an immediate back-up to the Sr. MM IP Administrative Assistant and will alternate on occasion to a primary role as needed.
Assist the Intake IP Coordinator with the inpatient hospital admissions and maintenance of the Excel Inpatient Assignment Grid.
Other duties as assigned.
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.
Occasional travel required
An Equal Opportunity Employer
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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.
JOB CATEGORY: Insurance