Payment Integrity Coding Specialist

REMOTE WORK: Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week.

Coding Specialist Responsibilities:

• Oversee maintenance of medical coding changes in our Payment Integrity programs
• Research requests using multiple systems (including: Sales Force, Jira, NPS) to provide all available details to reviewer
• Use SalesForce, Jira, and NASCO claim systems, to perform functions such as initial claim review, outcome reporting, and distribution based on triage
• Correspond with providers regarding decisions about requested services and obtain medical records when necessary
• Review and respond to issues and questions from internal and external customers, both verbally and in writing
• Work collaboratively with other departments to obtain additional information to resolve inquiries

Coding Specialist Qualifications:

• Bachelor’s degree, or equivalent combination of education and experience, with a minimum of 3 years’ experience in medical coding; In-depth knowledge of CPT, ICD-9, ICD-10, HCPCS, DRG diagnosis and procedure coding
• Formal coding certification (eg: CPC, AAPC) is a must
• Experience with both professional and facility claims coding and in APC, HIPPS, or RUG coding and validation

Coding Specialist Benefits:

• Health insurance (including vision)
• Dental coverage (free to employees)
• Wellness Program
• 401(k) with employer match + automatic employer contribution
• Life Insurance
• Disability Insurance
• Combined time off (CTO) – 20 days per year + 10 paid holidays
• Tuition Reimbursement
• Student Loan Repayment
• Dependent Caregiver Benefits