Claims Coding Specialist (Remote)
This job posting is no longer active.
SAMARITANHEALTHSERVICES
Req #: 61155
Corvallis, OR
1.0 (80 hrs/pp) - Day
SHS Health Plan Ops - Claims
Remote Status:
No
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JOB SUMMARY/PURPOSE
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Provides coding expertise and interpretation to the Claims Department and provides a focus on ICD-10 PCS and diagnosis coding. Provides guidance and expertise in the interpretation of ICD-10 coding as it pertains to the Company’s contractual pricing methodologies. Serves as an internal coding expert on issues related to claim qualification for contractual terms.
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DEPARTMENT DESCRIPTION
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Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.
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EXPERIENCE/EDUCATION/QUALIFICATIONS
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Bachelor's degree or equivalent experience in a related field required.
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Certified Coder credential from a nationally recognized coding association required.
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Experience and/or training in project coordination required.
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Two (2) years coding experience required.
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Experience and/or training in the insurance industry, claim workflows/processes, auditing contracts/system quality and navigating health information systems (including FACETS) preferred.
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KNOWLEDGE/SKILLS/ABILITIES
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Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
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Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
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PHYSICAL DEMANDS
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Rarely
(1 - 10% of the time)Occasionally
(11 - 33% of the time)Frequently
(34 - 66% of the time)Continually
(67 – 100% of the time)CLIMB - STAIRS
LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
LIFT (Knee to chest: 24"-54") 0 – 20 Lbs
LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
CARRY 1-handed, 0 - 20 pounds
BEND FORWARD at waist
KNEEL (on knees)
STAND
WALK – LEVEL SURFACE
ROTATE TRUNK Standing
REACH - Upward
PUSH (0 - 20 pounds force)
PULL (0 - 20 pounds force)
SIT
CARRY 2-handed, 0 - 20 pounds
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
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