Job details
Job type full-time
Full job description
See how you can make a difference! be part of an innovative company that cares about its associates and helps members enjoy the wonders of sight through healthy eyes and vision.
Versant health provides vision care to 39 million members nationwide! to ensure your continued success we provide opportunities for advancement and development.
Our associates remain engaged through a comprehensive compensation and benefits package which includes health and dental insurance, tuition reimbursements, 401(k) with company match, pet insurance and free vision insurance for you and your family.
Scope and purpose of position
The medical policy & coding analyst will be responsible for providing support for the clinical strategy & product department and other organizational departments such as claims and configuration to ensure timely communication and implementation of medical policy and code list updatesThis position will support the source document repository including validating cms and ama code sets and alignment to policies and proceduresThis role will ensure that medical policies are maintained with accurate and approved code updates, that all other associated source documents and systems are updated and will also ensure communication of code changes is completed and documented per established departmental processThis role will also be a key participant in client implementations in the development of client specific benefit code lists.
Essential functions
Review of cms and ama code sets providing analysis of code alignment to current product offerings (routine, medical optometry and medical/surgical services).
Tracking and documenting effective dates, notifications, and approvals of all coding related changes including cms code sets, ama code releases, and organizational coding change requirements.
Updating, tracking, and maintaining consistently accurate source repository cpt, hcpcs and icd-10 tables, following organizational workflow, and producing system reports are required
Analyzing, documenting, and preparing reports for national coverage determinations (ncd), local coverage determination (lcd), medicaid, and/or client custom code related criteria
Maintaining quality assurance and validation of work deliverables through established departmental quality assurance/audit process
Updating and communicating coding process schedules and artifacts per established departmental processes
Adhering to departmental set schedules for all activities.
Assist, as assigned, inter-departmental communication regarding code updates
Cpc support as required for special projects or assigned activities.
Education & experience
At least two years` work experience required as a cpc, preferably within a health plan or managed care organization
At least two years work experience with data analysis and artifact management
Must have strong data analysis experience related to icd-10, hcpc, and cpt codes
Associates` degree required
Strong general administrative skills including computer skills in ms office suite.
Understanding of quality and process improvement principles
Hipaa & security requirements
All associates must comply with the health insurance portability accountability act of 1996 (hipaa) as it pertains to disclosures of protected health information (phi) as described in the notice of privacy practices and hipaa privacy policies and proceduresAs a component of job roles and responsibilities, associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all timesAs a result, associates must explicitly adhere to all data security guidelines established within the company’s privacy & security training program.
We take pride in our recruiting process and follow a merit-based employee recruitment practice with extensive screening stepsWe will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.
We provide equal employment opportunities (eeo) to all associates and applicants for employment without regard to race, color, religious beliefs, age, sex (including pregnancy), sexual orientation, gender identity or expression (including transgender status), national origin, ancestry, status as a protected veteran or disabled veteran, physical or mental disability or history of disability, genetic information, marital status, or any and all other categories protected by under applicable federal, state or local law.
This policy extends to all associates and to all aspects of the employment relationshipAny associate who violates this policy will be subject to disciplinary action up to and including termination.
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Job activity
Posted 4 days ago
