Job Description

DescriptionThe Coding Policy Analyst is responsible for the coordination of technically detailed work that has a significant impact on all operations and information systems within Providence Health Plan (PHP). This position will update and create Coding Policies and associated edit configurations within the PHP claims editing system. The analyst is responsible for replying to provider and member appeals and providing appropriate CPT, CMS, specialty society, Coding Policy, and/or other official documented rationale for Coding Policy edits. The analyst will monitor changes to codes, coding guidelines and regulations, and coding edits from external agencies such as AMA, CMS, Medicaid and specialty societies, and assist with implementation of such changes to the claims adjudication and editing software. Extensive knowledge of AMA and CMS coding guidelines, policies, and regulations is required. The analyst will serve as a coding subject matter expert to other departments within PHP for questions about CPT, HCPCS, and ICD-10 codes, as well as coding guidelines and regulations. The analyst will work closely with the Benefits Management Team and Regulatory Department to ensure coding edits are applied in a manner consistent with member benefits and all state and federal insurance regulations.Remote EligibilityWashingtonOregonCaliforniaRequired QualificationsCoding certification through AAPC (CPC) or AHIMA (CCS) upon hire.5 years of experience directly related to CPT coding from chart extraction with a health care provider, a health insurance company, or a capitated managed care company.5 years of excellent writing and grammar skills required.5 years of demonstrated experience in detailed coding applications, as well as Microsoft Office capabilities, such as Excel, Word, and Access.Preferred QualificationsBachelor's Degree or experience in a Healthcare or Health Plan setting coding and auditing will also be considered.2 years of experience with Facets Claims Adjudication system and/or Optum CES editing software.Salary Range by LocationCalifornia: Humboldt: Min: $33.05, Max: $51.30California: All Northern California - Except Humboldt: Min: $37.08, Max: $57.56California: All Southern California - Except Bakersfield: Min: $33.05, Max: $51.30California: Bakersfield: Min: $31.71, Max: $49.22Oregon: Non-Portland Service Area: Min: $29.56, Max: $45.88Oregon: Portland Service Area: Min: $31.71, Max: $49.22Washington: Western - Except Tukwila: Min: $33.05, Max: $51.30Washington: Southwest - Olympia, Centralia & Below: Min: $31.71, Max: $49.22Washington: Tukwila: Min: $33.05, Max: $51.30Washington: Eastern: Min: $28.21, Max: $43.80Washington: South Eastern: Min: $29.56, Max: $45.88BenefitsComprehensive benefits package including a retirement 401(k) savings plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, paid time off, voluntary benefits, wellbeing resources, and more.Legal NoticeApplicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.J-18808-Ljbffr

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