* Position is eligible for Remote / Work from Home opportunity * Department: SMRC Med Review Telecommuting Eligible: Yes Job Grade: N14

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Job Title

Certified Coding Analyst

Job Summary

The Certified Coding Analyst performs coding analysis to ensure all claims billed to Medicare (Part A, B, & DME) are appropriately coded per coding standards and adheres to all Medicare rules and regulations. This position educates internal staff on coding standards and assists in the claim review process.

Key Performance Indicators

• Performs billing and coding analysis
• Provides coding education, advice, and guidance to internal staff and external entities
• Performs quality assurance reviews

Essential Functions Key Duties/Responsibilities/Accountabilities

• Reviews and analyzes professional complex claims and supporting documentation for CPT and Healthcare Common Procedures Coding Systems (HCPCS) Level II code verification to include accuracy and completeness.
• Reviews and analyzes complex facility/institutional claims and supporting documentation for Common Procedural Terminology (CPT), HCPCS Level II, Health Insurance Prospective Payment Systems (HIPPS), and International Classification of Diseases (ICD) code verification to include accuracy and completeness.
• Applies coding knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care.
• Makes coding determinations based on coding standards of practice and all applicable Medicare rules and regulations for facility/institutional claims.
• Conducts quality reviews through coding analysis and provides feedback to internal staff.
• Assists with annual coding updates.
• Develops, updates, and implements new hire, ongoing, and refresher training for coding and clinical staff.
• Stays up-to-date on all Medicare rules and regulations.
• Effectively communicates accurate and concise information with internal departments, providers/suppliers, and the Centers for Medicare & Medicaid Services (CMS).

Non-Essential Duties and Functions

• Other duties as assigned

Minimum Qualifications

• Associate degree in healthcare-related field OR equivalent work experience
• 3 years' experience in professional or healthcare billing
• CPC, COC, CIC, or other AAPC designated credential
• Demonstrated knowledge of Medicare (Parts A, B, & DME) rules and regulations
• Demonstrated knowledge of CPT, HCPCS, and ICD-10 rules and regulations
• Excellent written and verbal communication skills
• Advanced computer skills
• Demonstrated problem solving skills

Preferred Qualifications Above requirements and the following:

• Bachelor's degree in healthcare-related field OR equivalent work experience
• 5 years' experience in a professional or institutional billing
• Coding experience in multiple specialties
• Multiple coding certifications (CPC, CIC, COC, etc.)
• Certification as a Certified Professional Medical Auditor (CPMA) or Certified Documentation Expert Outpatient (CDEO) or willingness to obtain within one year of hire

Environment and Cognitive/Physical Demands

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting to 15 pounds
• Infrequent stooping

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Total Rewards Package:

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.

Below is the salary range for potential new hires.

Salary Range: $19.05 - $31.34

Other Compensation: Incentive Plan

Lifestyle Benefit: $50/month

This job will be closed 05/02/2024 at 8:00AM CST. No further applications will be considered.

American Acad Prof Coders (preferred)
CPC, COC, CIC or AAPC (required)
Cert Inpatient Coder (preferred)
Cert Outpatient Coder (preferred)
Cert Professional Coder (required)