Company Statement

Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions.  WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.

 

To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.
 

Coding Integrity Coordinator

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Administrative & Support
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ConnectiCare
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Serve as coordinator and support the Coding Integrity Program in the preparation of data files, records requests, reconciliation of data queries and other activities related to program management. Perform administrative functions to support the successful outcomes of the program.
Responsible for upholding the standard for code review functions in the setting of claims review, grievance and appeal, and new medical policy implementation.


Responsibilities:

  • Review and sort all incoming records to identify correct requesting department.
  • Distribute the records to the appropriate department.
  • Compile and enter program activity data and provide routine reports to support program operations.
  • Prepare and validate reporting for outlier provider claims and request patient medical records to assign diagnoses, treatments, as well as surgical and non-surgical procedures for facility and medical services for coding and payment integrity.
  • Provide direct education to the business and provider offices as needed to facilitate an understanding of correct claim coding, use of CPT, ICD-10, HCPCS, etc.
  • Identify billing, reimbursement, and coding variances from industry standards and brings to leader’s attention.
  • Provide support for internal and vendor edit reviews and provider contracts.
  • Track outcomes analyze data and provide reporting as required to identify provider education opportunities.
  • Ensure daily production log and team database is maintained.
  • Work with physicians, hospitals, and internal staff to gather information needed to resolve program issues.
  • Research and resolve provider inquiries regarding coding integrity program, as well as prepare and document cases for clinical or compliance review in accordance with the determination.
  • Participate in RPC, RPCW, Medical Policy Committee (MPC) and Medical Policy Committee Workgroup (MPCW) as added Coding Integrity representation at meetings, to ensure that decisions are appropriate and will result in accurate claim reimbursement. 
Qualifications: 
  • Associates degree in a health care related field; Bachelor’s preferred.
  • AAPC CPC® (AAPC Certified Professional Coder) &/or CCS (AHIMA Certified Coding Specialist) preferred
  • 1 - 2 years of relevant, professional work experience. (R)
  • Additional experience/specialized training may be considered in lieu of educational requirements. (R)
  • Knowledge of medical terminology, provider reimbursement, ICD-10 and CPT coding, coordination of benefits and all types of medical claims. (R)
  • Proficient in MS Office (Word, Excel, Access, Powerpoint, Outlook); ability to use data to generate reports. (R)
  • Strong working knowledge of relational database principles and software packages/applications. (R)
  • Ability to effectively handle projects and tasks with multiple priorities and deadlines. (R)
  • Excellent communication skills (verbal, written, presentation, interpersonal). (R)

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