Coding Specialist

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. Come join us and be part of a purpose driven company who is invested in your future! Minimum Salary Range Job Summary This Position Is Responsible For Being The Subject Matter Expert For The Translation Of The Icd9 Claims To Icd10, Identifying Correct Mappings And Assisting In The Validation Of Business Decisions Based On The Codes Sets, Responding To Inquiries On Translation Of Codes And Resolving Issues, Providing Training To External Providers And Internal Staff, Assisting With Audits Of The Correct Coding For Claims, Providing Assistance For Investigative Auditing, Composing Policy And Procedure Updates Which Are Affected By Clinical Coding , And Recommending System And Control Enhancements To Reduce The Potential For Adjudication Errors Due To Coding Issues. Responsibilities *Act as Subject Matter Expert and Lead in the translation of ICD9 codes to ICD10 using General Equivalent Mapping. Evaluate current code mappings for CPT codes and HCPCS, and determine the appropriate translations to new or updated codes sets. Assist Management in assessing the required HCSC roles to establish and maintain an Enterprise coding competency model. *Develop and implement coding focused educational/training material, reference tools, etc. that support developing and maintaining enterprise established coding competency models for both internal personnel and externally (providers). *Research and resolve internal inquiries regarding issues of correct coding from a variety of areas within HCSC. *Document coding review findings which may be pursued to support internal audit reviews and internal/external inquiries or reviews by other areas within HCSC. *Perform claim reviews to determine compliance with established corporate/divisional coding and claims submission polices and procedures. *Provide recommendations to management that may be used in the development of cross-divisional implementation of new claims auditing logic and claims payment system logic. Recommend system and control enhancements to reduce potential for adjudication errors. *Work with the HCSC Training and Development Leadership to assist in identifying training opportunities and materials. *Keep up-to-date with current changes/updates/new practices in coding. * Compose policy and procedure updates to manuals and other documentation which involve clinical coding. *Acquire and maintain expert knowledge regarding provider related systems including Member, Blue Chip, Blue Start, IIMAGE, IRIS, TCHI, ISIS and Blue Card. *Provide assistance for investigative auditing for fraud, abuse, etc. by reviewing trends, etc. Required Job Qualifications: *Bachelor Degree OR 4 years of work experience in the health care industry. *Plus 4 years experience in health care industry including 2 years working with coding structures and claims auditing logic. *Coder Certification (AHIMA, AAPC). *Medical terminology and human anatomy familiarity. *Customer Service skills and experience in a customer service setting. *Clear, concise verbal and written communication skills including interpersonal skills to work across organizational lines and to work with providers. *Business writing skills to compose procedures, policies and training materials. *Analytical and quantitative skills. *PC skills and proficiency (Word, Excel, Access, PowerPoint). *Experience managing multiple priorities and meeting deadlines. *Facilitation skills. *PC computer skills (EXCEL, Word). Preferred Job Qualifications: *Experience with Blue Chip, CISCS, Image, Claims or member and provider related systems. *Trainer experience with ICD9 coding. *Experience in claims processing operations and contract administration. Are you being referred to one of our roles? If so, ask your connection at Workday about our Employee Referral process! HCSC Employment Statement: HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.