What are the responsibilities and job description for the Medical Coding Analyst position at System One?
ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.
Medical Coding Analyst - 3 roles are open
100% Remote
Contract position
The Medical Coding Analyst III develops, documents and maintains code level benefit definitions at the Enterprise level for a multi-state and multi-market organization.
Essential Functions:
- Monitor perform and document peer review of code level benefit definitions. Identify and implement opportunities for improvement
- Create and maintain department SOPs and supporting process flows
- Collaborate with Configuration to define business requirements associated with code level data related to Member Benefits. Drive resolution of conflicts between benefits and code edit system
- Research and interpret complex regulations across all markets to ensure compliance
- Utilize correct coding guidelines across all product lines
- Integrate Essential Health Benefits, State Provider agreements, CMS requirements, state-specific regulations, Mental Health Parity, etc. and resolve information source conflicts
- Participate in annual benefit change process with Product leads and Member Benefits Analysts
- Develop and utilize reports to analyze and stratify data in order to provide answers to member benefit issues identified within the department or by other departments
- Collaborate with the Policy Department on Payment and Medical Policy development
- Collaborate with Leadership and Member Benefits Analysts to communicate opportunities based on industry standard coding practices
- Participate in Cross-functional Projects and Market Regulatory meetings as subject matter expert
- Review, respond and implement Regulatory changes accurately and timely
- Investigate and resolve complex issues
- Serve as a mentor to other coding analysts
- Build meaningful relationships with other teams and departments in the organization
- Facilitate Cross functional meetings
- Manage implementation and maintenance of Benefit Management Tool
- Perform any other job duties as requested
Education and Experience:
- Bachelor's degree in a related field or equivalent years of relevant work experience is required
- Minimum of five (5) years of medical coding experience required
- Managed Care experience is preferred
Competencies, Knowledge and Skills:
- Advanced computer skills with Microsoft Suite
- Proven understanding of database relationships preferred
- Subject Matter Expert in CPT, HCPCS and ICD-CM Codes required
- Critical listening and thinking skills
- Problem solving skills
- Enhanced communication skills both written and verbal
- Ability to work independently and within a team environment
- Attention to detail
- Ability to understand the upstream and downstream impacts of code level benefit details
- Knowledge of Medicare, Medicaid or Marketplace insurance benefits required
- Claims processing knowledge strongly preferred
- Ability to work in a fast-paced environment managing multiple priorities
- Build and Maintain strong working relationships with cross-functional teams
- Strong interpersonal skills and high level of professionalism
- Facets knowledge/training preferred
Licensure and Certification:
- Certified Medical Coder (CPC, RHIT or RHIA) is required
For immediate consideration, please apply directly or contact Patrick Jackson at pjackson@altaits.com or (513) 571-6254.
