Medical Coding SME Job in Indianapolis 46204, Indiana Us
* identify policy related items in the system and will work with stakeholders in developing appropriate ICD-10 policies.
* as medical policies related to ICD-9 coding are identified, recommendations must be developed for accurate and appropriate conversion to the new medical coding scheme - ICD-10 - which represents an eightfold increase in coding structure.
* position requires an understanding of medical terminology and practice, clinical information required for claims processing, and the ability to perform in depth research and analysis of existing policy as well as extracting policy from the system to help client identify new policies options and recommendations.
* clinical, payor-side (insurance) and Medicaid experience required.
Qualifications:
* Must have five or more years of direct medical claim or outpatient hospital facility administrative review/appeals experience.
* Proficiency in healthcare insurance reimbursement including benefit investigations, research activities, clinical interpretation, appeals, Medicare and Medicaid program, and other health care provider dispute resolution actions.
* Must have strong writing skills and excellent organizational ability.
* Strong customer service skills and physician relationship skills along with the ability to do multiple tasks are keys to success in this position.
* Effective problem solving skills, an attention to detail and strong verbal skills are also important.
* Clinical knowledge is essential to position as well as knowledge of correct coding rules.
* Demonstrates knowledge and understanding of current laws and policies pertaining to Health Data.
Education Requirements:
* Requires certification by the American Academy of Processional Coders or the Board of Advanced Medical Coding or The American Health Information Management Association. Multiple certifications preferred. Bachelor's degree or relevant clinical degree and licensure (LPN; RN, RHIA, RHIT) preferred.