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The Medical Coding Analyst is responsible for conducting retrospective utilization and coding reviews for all inpatient and outpatient healthcare services including application of coding guidelines and/or clinical criteria, training/mentoring other team members, and performing preliminary research on requested topics. In addition, this role will provide subject matter expertise and support in the validation of medical code assignments and sequencing and claims.

This position can be home-based in one of the following states: Colorado, Iowa, Illinois, Idaho, Maryland, Massachusetts, Montana, Oklahoma, Mississippi, Wyoming, Pennsylvania, Virginia, or Washington, DC. Individuals residing outside of one of the approved states will not be considered.

Essential Functions

• Performs prospective, concurrent, or retrospective utilization review for all services based on the contract, state, or URAC requirements.
• Performs coding validation to ensure that the diagnoses/procedures submitted on the claim are supported by the clinical record documentation and appropriate billing by contract.
• Screens individual situations according to applicable coding guidelines to determine if coding is appropriate.
• Refers cases that fail to meet screening criteria to peer reviewers.
• Coordinates and participates in peer-to-peer reviews as warranted.
• Serves as liaison between peer reviewer, provider, and/or facility. Coordinates and participates in the appeal process as directed by management.
• Trains or serves as a mentor to team members and physician reviewers to ensure reviews and appeals are conducted thoroughly and within specified time frames.
• Documents review and special project results in workflow documentation system, ensuring data is accurate and timely.
• Assists in compliance reporting.
• Performs preliminary research on topics such as coverage determinations, coding guidelines or standards of care.

Requirements

• Two-year degree and/or equivalent experience
• Two years minimum experience in inpatient and/or outpatient coding
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Assistant (CCA), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) is required
• Experience with ICD coding and concepts as well as CPT and HCPCS coding required
• Intermediate experience working with Windows and PC-based software products
• Experience working in a deadline-driven environment and handling multiple tasks required

Preferred Skills/Certifications

• Certified Professional Medical Auditor (CPMA)
• AAPC (American Academy of Professional Coders)
• AHIMA (The American Health Information Management Association)
• Certified Professional Medical Auditor (CPMA)
• Certified Professional Coder + Certified Professional Biller (CPC + CPB)
• National Correct Coding Initiative
• Familiarity with Medicaid, Medicare, and Managed Care Organizations

COMMITMENT TO SAFETY

As part of our commitment to health and safety, some roles may require additional health protocols (i.e. personal protective equipment or vaccination)

Who We Are:

Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.

Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions.

Our business is our people and we're looking for talented individuals who not only believe in our mission but who are ready to take wnership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do at www.telligen.com/about-us

Are you Ready?

We're on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity and Integrity.

Ownership: As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win.

Community: Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other.

Ingenuity: We're a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we're all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away!

Integrity: Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence.

Thank you for your interest in Telligen!

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Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability), and E-Verify Participants.

Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time.

Telligen does not accept 3rd party solicitations from outside staffing firms.

Telligen and its affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability) and E-Verify Participants.