Benefits Coding Specialist

Company Overview: 

Join us in our mission to transform healthcare! RxAdvance, now doing business as nirvanaHealth, is committed to bringing the art of possible to the payer and PBM industries, which is why we strive to invest in our employees throughout all stages of life. Success radiates through all levels of employees here, with competitive benefits, a strong focus on employee wellness, and optional education courses offered through UDEMY: we aim to support all aspects of employee growth.  

Characterized by curiosity, innovation, and an entrepreneurial mindset, nirvanaHealth is the first to offer medical and pharmacy benefit management solutions that run on the same platform, made possible by our creation, Aria – the first robotic process automation cloud platform designed for healthcare.  

Led by our chairperson John Sculley (former Apple CEO) and noted healthcare entrepreneur and founder of ikaSystems Ravi Ika, nirvanaHealth endeavors to sizably reduce the $900 billion in waste in healthcare administrative and medical costs. We are seeking A-players to join our team – folks who embrace the grind and hustle of a growing company, are collaborative and innovate, are life-long learners and growers, and have an entrepreneurial and positive mindset. 

Job Summary: 

The Benefits Coding Specialist is responsible for determining action steps and calculations necessary to make an accurate payment. This includes but is not limited to; COB, high dollar, dialysis, DME, Behavioral Health, hospital exclusions, and claim adjustments in an accurate and expedient manner. 

Job Responsibilities (but not limited to): 

• Responsible for assigning and configuring correct codes on the system to describe the type of service received on patient claims. 
• Assign codes for reimbursements; research and is compliant with regulatory requirements utilizing guidelines.
• Assign diagnosis and procedure codes for clinic visits and surgical procedures/deliveries -Interact with other team members to assist with inquiries regarding coding, documentation, denials, and billing.
• Ensure codes are assigned correctly and sequenced appropriately as per government and insurance regulations.
• Receive and review patients’ charts and documents for verification and accuracy.
• Collect information made by the Physician from different sources to prepare monthly reports.
• Implement strategic procedures and choose strategies and evaluation methods that provide correct results.
• Maintain communication with Management and Providers to ensure timely notification of identified documentation issues.
• Comply with medical coding guidelines and policies. 
• Research and analyze data needs for reimbursement.
• Review and verify documentation to support diagnoses, procedures, and treatment results.
• Identify diagnostic and procedural information.
• Research, analyze, recommend, and facilitate plan of action to correct discrepancies and prevent future coding errors.
• Serve as resource and subject matter expert to other coding staff.
• Review provider documentation for coding appropriateness and accuracy.
• Responsible for training the team on processing complex medical claims.

Qualifications: 

Education and/or Training:

• Bachelor's degree required or relevant experience in claims/customer service with Medicare Claims and Benefits Coding.

Professional Experience:

• 2 years of work experience as a medical coder.

Licenses/Certifications:

• CPC (Certified Professional Coder), preferred.

Specialized Skills:

• Medicare/Medicaid experience, preferred. 
• Understanding of healthcare industry is required.
• Well versed with CPT, ICD-10 and HCPCS codes.
• Deep understanding and processing of CMS1500 and CMS1450 (UBO4).
• Advanced verbal and written skills.

Technical Skills:

• Strong PC skills; MS Word, Excel, Access, and Power Point.

Additional Considerations:

• Applicants must be able to pass a background investigation as all offers are pending a successful completion of background check per the company policy.