Presbyterian Healthcare Services
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CODING DATA SPECIALIST - PROVIDER CONTRACTING
at Presbyterian Healthcare Services
- Requisition ID
- Default: Location : City
- Location : Name
- Rev Hugh Cooper Admin Center
- Default: Location : State/Province (Full Name)
- New Mexico
Type of Opportunity: Full Time
Work Schedule: Days
This position exists to ensure the oversight and compliance with Health plan coding policies and procedures; compliance to all external regulatory agency coding rules and regulations. Responsibilities include review and recommend compliance of coding policies and procedures for the Health Plan as it pertains to the Coding Editing System. Compliance with all external regulatory agencies (CMS, HSD, etc.), in regards to coding rules and regulations and work directly with the coding rule developer/manager to implement regulatory guidelines into the Coding Editing System; Provides coding specific education to internal workgroups, providers, and clinical personnel in regards to compliance with health plan policies and regulatory agencies; Assisting other Health Plan Departments in answering coding questions.
*Liaison to the Provider Network, Claims, Health Services, Configuration and Coding Developer/Manager staff and leadership in regards to addressing functional coding issues and problems.
*Works closely with Coding Developer/Manager and Claims in order to ensure coding configuration updates are implemented in a timely manner with little to no disruption of daily business operations.
*Responsible for reviewing the documentation that supports the application of correct coding edits in the event they are questioned by providers, or if necessary, legal challenges.
*Responsible for retrieving, interpreting, maintaining and disseminating up-to-date knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-10, CPT-4, HCPCS, APC Local Coverage Determination, and National Coverage Determination and any CMS updates and changes where they pertain to Coding Edits
*Researches and responds to inquiries and requests daily regarding coding issues and problems and ad-hoc analysis for the health plan; Maintains up-to-date working knowledge of all Health Plan coding system applications.
*Conducts training classes in areas of coding, documentation and compliance for PHP personnel. This includes preparation of training materials, educational audits and answering specific situational questions.
*Responsible for reviewing all edits on a monthly, quarterly and yearly basis to determine if edits are still valid and if any updates may be necessary; Attends all meetings where code edits may be impacted and bring all documentation back and make sure the edits get implemented in a timely manner.
Bachelors degree in business administration or health care field required. 6 years of additional experience can be substituted in lieu of degree. CPC required. CCS, CCS-P, CPC-H, RHIA, or RHIT certification/credential/degree/license preferred, AND three to five years experience in healthcare ICD-10, CPT-4, HCPCS coding, and medical terminology. Excellent written and verbal communication skills. Detail and results oriented. Ability to work within a team and independently Ability to make independent decisions.
* Bachelor Degree
* Certified Professional Coder
Benefits are effective day-one (for .45 FTE and above) and include:
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.
New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. </