About the Role:

• We are looking for a Coding Specialist to act as an internal expert in ensuring the development and implementation of value-based reimbursement and medical policy models.
• The Coding Specialist will provide advanced knowledge to support effective partnerships with provider entities and guidance on quality measure capture and proper use of CPT and ICD 10 codes in claims submissions.

Responsibilities:

• Consult on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes.
• Provide input on various consequences for different financial and incentive models.
• Support the use of alternatives and solutions to maximize quality payments and risk adjustment.
• Serve as a technical resource/coding subject matter expert for contract pricing related issues.
• Conduct business and operational analyses to assure payments are in compliance with contracts.
• Provide problem-solving expertise on systems issues related to coding and billing.
• Support the development and refinement of guides and resources for providers on billing methodologies to maximize quality and STARs outcomes.
• Keep up-to-date on coding rules and standards.

Education Qualification:

• Bachelor's degree in Health Information Management or related field.
• Certified Professional Coder (CPC) certification preferred.