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Sr Coding Analyst

Company Name:
BlueCross BlueShield of North Carolina
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AutoReqId 11952BR
Job Title Sr Coding Analyst
Business Function Nursing and Healthcare Professionals
Department Medical Policy
Position Location Chapel Hill
Major Responsibilities Provides technical, clinical and coding expertise to support coding related projects. Consults/collaborates with all plan areas regarding national coding standards and applicability to BCBSNC claims processing systems and reimbursement policy. Presents findings and trends in coding practices to internal/external audiences and makes recommendations regarding coding standards.
Major Job Functions/Components
o Provide consultative expertise to other areas (e.g. Compliance, Legal, Network Management and Medical Policy) regarding current and emerging coding/documentation issues.
o Develop policies and standard operating procedures for medical review area as applicable to ensure compliance with regulatory agencies, state and federal law and ensure consistency of reviews.
o Identify trends in coding practices to internal/external audiences and make recommendations regarding coding standards.
o Assimilate necessary documentation, including medical records, and apply clinical coding expertise to evaluate appropriateness of provider coding and assess medical necessity of services rendered with referral to Medical Director as appropriate.
o Gather appropriate claims data, analyze and prepare summary of analysis to assist in the development of resource allocation strategies to meet changing business needs.
o Respond to provider letters of inquiry regarding specific medical procedure coding issues and provide education on proper coding techniques via written and/or telephonic communications.
o Develop education materials for providers identified as outliers and collaborate with Network Management on delivery/communication of information to provider.
o Maintain documents for tracking audit results, status/outcomes of reviews etc.
? Participate in or lead special projects based on business area needs requiring independent, sound decision making and broad based understanding of impact on the individual department as well as impact on corporate objectives.
Requirements o Registered Nurse with valid NC license
o 5 years clinical experience. 3 of these years must include coding experience.
OR
o Licensed Practical Nurse with valid NC license
o 7 years clinical experience. 3 of these years must include coding experience.
o Certified Professional Coder
Employees in the HIPAA Program Office will have one year from entrance into the position to obtain certification.
Additional Critical Skills & Knowledge Needed for Job Experience with multi-specialty clinic
Understanding medical criteria, medical guidelines, medical policy and NCQA, DOI, Medicare/CMS regulations.
Ability to use automated systems to identify, analyze and resolve problems
Excellent oral and written communication skills.
Accuracy and attention to detail.
Ability to analyze and present complex data/information to all levels of expertise.
Ability to demonstrate critical thinking skills.
Thorough knowledge and understanding of medical terminology.
PC skills operating Microsoft Office Suite.
Knowledge of BCBSNC benefits plans and operating systems.
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, Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

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