Job Summary:

The Coding Analyst II develops, documents, and maintains code level benefit definitions at the Enterprise level for a multi-state and multi-market organization.

Essential Functions:

• Utilize correct coding guidelines to research and interpret complex regulations while collaborating with policy and markets to ensure compliance and resolve conflicts
  i.e. Integrate Essential Health Benefits, Prior Authorization requirements, State Provider agreements, CMS requirements, state-specific regulations, Mental Health Parity, etc.
• Create, maintain, review, and analyze configuration templates to validate benefit requirements and regulations are accurate
• Perform peer review of configuration templates and provide documentation of results within the defined Service Level Agreements (SLA) guidelines; identify opportunities for process improvement
• Communicate effectively with various internal departments to enhance cross-functional awareness, promote process improvement, and identify root cause resolution of issues
• Participate in the annual benefit change process with Product Management and Benefit Analysts as appropriate per market
• Utilize reports to analyze data to assist with issue resolution
• Research and identify industry standard coding practices to stay current and communicate to the BC&S team
• Adhere to defined SLAs while also accommodating urgent requests
• Participate in the review and updates of the SOPs
• Update and maintain the data management tool
• Attend and support internal/external meetings
• Participate in projects as assigned
• Assist in the training of new hires and continuous training of department peers
• Back up to all Coding Analyst functions
• Perform any other job-related functions as requested

Education and Experience:

• Bachelor's degree in a related field or equivalent years of relevant work experience is required
• Minimum of two (2) years of medical coding or medical billing experience required
• Managed Care experience is required, preferably associated with benefits coding, claims processing, and / or benefit configuration

Competencies, Knowledge and Skills:

• Intermediate computer skills with Microsoft Suite
• Proven understanding of database relationships preferred
• Extensive knowledge of i CPT, HCPCS and ICD-CM Codes
• Working knowledge of other claims related reference data, such as types of bill, revenue codes, places of service
• Critical listening and thinking skills
• Proven understanding of the upstream and downstream impacts of code level benefit details
• Problem solving skills
• Communication skills both written and verbal
• Ability to work independently and within a team environment
• Attention to detail
• Knowledge of Medicare, Medicaid or Marketplace insurance benefits preferred
• Claims processing knowledge preferred
• Ability to work in a fast-paced environment managing multiple priorities
• Ability to build and maintain strong working relationships with cross-functional teams
• Strong interpersonal skills and high level of professionalism
• Facets or other systems knowledge/training preferred
• Knowledge of regulatory requirements of Outpatient Prospective Payment System (OPPS) and other payer requirements, preferred
• Excellent organizational skills, and ability to meet deadlines

Licensure and Certification:

• Certified Medical Coder (CPC, RHIT or RHIA) is required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.