PHRN - Medical Coding Operations Expert

4 weeks ago

Metro Manila Philippines Carelon Global Solutions Full time

Overview Responsible for providing domain-expertise, process-related guidance, may assume quality audit, trainer/ coding instructor and/or team management leadership and support, as per business need. Primary duties may include, but are not limited to: Responsibilities Serves as a first line resource for operation associates for workflow and technical related processes; provides operational training; assists associates by answering day-to-day technical questions; encourages a teamwork environment; monitors inventory to ensure workflow remains uninterrupted; handles complex case research and resolution; reviews, interprets and maintains records of service level, quality, accuracy, and productivity; reviews department policy and procedure manuals for accuracy; works with stakeholder partners/ departments to ensure procedures and policies are accurate and complete. Qualifications Minimum 5 years related experience and 3 years of experience and expertise with company relevant automated processing systems; or any combination of education and experience, which would provide an equivalent background. Previous leadership, quality audits and/ or training experience preferred. Suggets and develops high quality, high value, concept and or process improvement and efficiency recommendations. Requires current, active, unrestricted Registered Nurse license in applicable state(s) or territory of the United States. Minimum of 2 years hospital experience and/or several years of inpatient hospital coding experience. One or more of the following certifications are preferred: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred. Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred #J-18808-Ljbffr

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