ESSENTIAL QUALIFICATIONS:
EDUCATION: Bachelor’s Degree or equivalent combination of education and experience.
CREDENTIALS/LICENSURE: Certified Professional Coder or RHIT is required; Certified Auditor or HIM designation is preferred.
MINIMUM EXPERIENCE: 2 years of experience coding, reimbursement analysis, insurance issue resolution and medical record auditing. Previous experience with primary care and multi-specialty care preferred and other relevant experience would include health care operations or process improvement work with a health care insurance organization. Health Information Management, and data management experience is highly desirable.
POSITION REQUIREMENTS (ABILITIES & SKILLS):
- Ability to apply complex coding rules, numerous payer rules and standards.
- Ability to serve as a role model for ethical management behavior, continuous improvement and promotes awareness and understanding of IHA's Standards of Care and Compliance Plan.
- Demonstrated understanding and/or hands-on experience with office processes, procedures and workflows.
- Subject matter expert knowledge of managed care and insurance practices, insurance claims and billing process, fee schedules and pricing. Ability to research billing guidelines effectively to provide direction on compliance coding.
- Maintains substantial working knowledge of federal, state and insurance company regulations and contract requirements affecting compliance in a healthcare setting; including compliance plan and auditing standards.
- Ability to independently review and apply high critical thinking skills, consider medical necessity of the presenting problem and analyze levels of medical decision-making.
- Ability to apply logic to assumptions and decision-making for areas that are not a black or white assumption.
- Proficiency in multi-tasking and meeting sensitive deadlines in a fast-paced environment with a personal commitment to producing the highest quality work and providing extraordinary customer service; demonstrated ability to effectively follow through on assigned projects.
- Possess excellent customer service and problem-solving abilities, collaborative and positive coaching skills.
- Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, Microsoft Word and Excel, PowerPoint, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job including EPM and EHR systems.
- Excellent professional communication skills in both written and verbal forms, such as via query, including proper phone etiquette. Ability to speak before groups of people, either in-person or virtually.
- Ability to create education materials, implement and present effective group educational sessions to providers.
- Ability to work collaboratively in a team-oriented environment; displays courteous, professional and friendly demeanor.
- Ability to work effectively with various levels of organizational members.
- Good organizational and time management skills to effectively juggle multiple priorities and time constraints in a fast-paced environment.
- Ability to exercise sound judgment and problem-solving skills.
- Ability to maintain any organizational information in a confidential manner.
- Successful completion of IHA competency-based program within introductory and training period.
- Ability to travel to offices and other training sites to educate staff and/or providers.
- Ability to work overtime hours as scheduled.
MINIMUM PHYSICAL EXPECTATIONS:
- Physical activity that often requires keyboarding, filing and phone work.
- Physical activity that often requires extensive time working on a computer and sitting.
- Physical activity that sometimes requires walking, bending, stooping, reaching, and/or twisting.
- Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs.
- Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
- Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
- Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.
MINIMUM ENVIRONMENTAL EXPECTATIONS:
This job operates between working in a typical office environment which involves frequent interruptions and significant interaction with people which can be stressful at times.
