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Senior Coding Analyst / Coding Analyst

Employer
Blue Cross Blue Shield of ND
Location
Fargo, North Dakota
Salary
Join our team!

View more

Industry
Technology
Role
IT
Job Type
Long-Term
Hours
Full Time

Job Details

All about us

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.

 

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

 

Work environment

This opportunity is eligible for remote work or a hybrid work arrangement. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

This position is eligible for internal and external applications.

Pay information

Pay Level: 021, 022

FLSA Category: Non-Exempt Hourly

 

A day in the life

The Fraud and Abuse Coding Analyst reviews claims and corresponding medical records to verify appropriate coding, billing, and compliance with Company policy. This position determines the most effective method of auditing and documents clear justification to support findings. This position will also be responsible for identifying potential fraud, waste and abuse using software, tips, data analysis, etc. and works across departments for the reprocessing of claims and provides education on fraud, waste, and abuse.

 

Your responsibilities will include

Level I
  • Reviews professional, institutional claims and corresponding medical records to verify that coding and billing are appropriate based on current guidelines and policy. Determines the most effective and efficient methods of auditing based on each case. Analyzes the data collected from internal and external resources that supports the audit. Document steps and preserve evidence per established procedures.
  • Documents clear justification to support all irregular findings. References the appropriate sources used to support findings. Records the financial impact of incorrect coding into the case management system. Communicates findings effectively with providers in both written and verbal form.
  • Identifies potential fraud, waste or abuse using software, tips, data analysis, and other available means. Analyzes the appropriateness of proceeding with an investigation or audit. Starts the audit process based on findings.
  • Works across departments to facilitate the reprocessing of claims, enhance system edits based on case findings, and provide education on fraud, waste, and abuse. Helps conduct training for both internal and external clients on new coding initiatives.
  • Serves on committees and special projects, as assigned.

Senior
  • Performs complex audits including professional and institutional claims.
  • Monitors the research and escalation of critical items or issues and brings recommended solution(s) to leadership for final decision and/or forward path for resolution.
  • Assists leadership in evaluating and updating processes and procedures within the department driving efficiencies where needed.
  • Trains, coaches, and mentor’s department staff and collaborates with leadership to support strategic goals within the team.
  • Acts as a resource person for internal and external customers regarding coding and billing practices.
  • Acts as a liaison with third-party auditors.
  • Prepares up-to-date news articles on request of management and represents the company at presentations outside organization meeting, as approved by management.
  • Submits any recommendations for internal process improvement to prevent future fraud, waste, or abuse occurrences to management team.
  • Manages a full case load by performing multiple audits concurrently with audit oversite to ensure thorough review and resolution.

 

What you need to succeed
  • A degree in Healthcare Administration, Business or a related field.
    • Level I: Associate's  
    • Senior: Bachelor's
  • Experience in clinical or medical coding, claims administration, claims auditing or related experience. 
    • Level I: 3 years
    • Senior: 5 years
  • A Certified Professional Coder (CPC), Registered Heath Information Technician (RHIT), Registered Heath Information Administrator (RHIA), or similar certification is required. 
  • Communicate well both in writing and verbally with internal and external stakeholders. 
  • Organized and proficient in prioritizing work in a changing environment. 
  • Ability to analyze and resolve problems, make suggestions and implement process improvements.

 

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

 

Benefits and perks
  • Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
  • Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
  • 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
  • Employee recognition, community initiative events and yearly company outings.
  • Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
  • Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.

 

Job posting policy

Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.

 

Equal opportunity employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com.

This job posting will be closed 3/23/2023 at 8:00 a.m. (CT). No further applications will be considered.

Company

TWO WORDS – MEMBERS FIRST.

That sums up why we’re here. And according to member satisfaction surveys, 95.6% say we’ve done a great job at maintaining that focus.

With that said, there are still mountains to move. America’s health care system needs an overhaul and Blue Cross Blue Shield of North Dakota is taking a lead role. To accomplish that, we need BOLD people who believe they can make an impact.

Are you ready to shake up an industry?

If you’re passionate about taking on our nation’s number one health care concern, there may be a place for you on one of our teams.

Company info
Website
Location
4510 13th Ave. S.
Fargo
ND
58103
United States

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