Blue Cross Blue Shield of Arizona
Peoria, Arizona, United States
Certified Medical Coder (Hybrid)
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Job Description
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona and willing travel to Prosano Health Clinics in Maricopa County 2-3 times per week.
Schedule: Monday - Friday 8am - 5pm
Reviews, resolves, and responds to requests for corrections to previously processed claims and provider grievances that alter the application of benefits or pricing. Support and aid in the processing and review of Prosano Health encounters to payer. Additionally, this role will be responsible for conducting analysis, education, and training on medical and clinical diagnoses, procedures, and other activities to translate to appropriate coding designations.
REQUIRED QUALIFICATIONS
Required Work Experience
- 4 years of experience in healthcare related field
Required Education
- High-School Diploma or GED in general field of study
Required Licenses
- N/A
Required Certifications
- CCS Certified Coding Specialist or CPC Certified Professional Coder or CCA Certified Coding Associate Certification
- And CRC Certified Risk Adjustment Coder Certification
Preferred Work Experience
- At least 2 years of value-based medical, quality, and diagnostic coding in outpatient/primary care settings
- Associate's Degree in general or healthcare related field of study
- N/A
- N/A
- Support Provider Training and Education on coding standards and workflows (ex. HCPCS CPT-4, ICD-10, HCCs, CPT-2 best practice and tips)
- Consult on the configuration of Prosano Healths EMR to maximize coding efficiencies.
- Present trainings on site at Prosano Health locations
- Prepares coding 1 pagers, education materials, and content to support department performance.
- Reviews, researches, and corrects claims/encounter errors and processing issues, rejections, etc.
- Maintains effective communication with internal and external customers. Prepares written correspondence to explain results of error reviews.
- Maintain complete and accurate records per department policy.
- Ensures that the code assignments are supported by documentation, within the body of the medical records.
- Meet quality, quantity, and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
- Demonstrate ability to apply plan policies and procedures effectively.
- Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
- Participate in continuing education and current developments in the fields of medicine.
- Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
- Demonstrate ability to work in fast-paced environment and prioritize effectively where multiple work demands and projects may be present simultaneously.
- Provides prompt follow up with clinicians when additional documentation or queries are generated and required to close out coding activities.
- Attain/Maintain relevant professional certifications and continuing education to support as required
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.
REQUIRED COMPETENCIES
Required Job Skills
- Intermediate PC proficiency
- Intermediate skill in use of office equipment, including copiers, fax machines, scanner, and telephones.
- Knowledge of CPT-4, HCPCS and modifier usage, ICD-10 coding, DRG codes, CPT2 coding, HCC coding and documentation
- Experience with EMR billing systems and workflows
Required Professional Competencies
- Maintain confidentiality and privacy.
- Advanced medical terminology knowledge
- Compose a variety of business correspondence.
- Interpret and translate policies, procedures, programs, and guidelines.
- Capable of investigative and analytical research
- Navigate, gather, input, and maintain data records in multiple system applications.
- Follow and accept instruction and direction.
- Establish and maintain working relationships in a collaborative team environment.
- Organizational skills with the ability to prioritize tasks and work with multiple priorities.
- Independent and sound judgment with good problem-solving skills.
- Create education and training materials and presentations for clinical and non-clinical learners.
- Must be able to travel across Maricopa County to provide on-site education and trainings
Required Leadership Experience and Competencies
- N/A
PREFERRED COMPETENCIES
Preferred Job Skills
- Advanced PC proficiency
- Advanced Experience with Athena billing systems and workflows
Preferred Professional Competencies
- Experience with presenting training and education to clinical and non-clinical audiences, preferred
Preferred Leadership Experience and Competencies
- N/A
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.