Coding Payment Integrity Specialist Pr

Blue Cross & Blue Shield of MN and Blue Plus – Eagan, MN


This position is responsible for ensuring appropriate use of health care resources by conducting pre and post payment chart review/auditing, analyzing new payment integrity coding opportunities and providing consultation on coding to other teams on appropriate billing and practices.   The incumbent provides in depth knowledge of current coding practices, billing practices, health plan benefit structure and claims payment knowledge to this role.   They will lead efforts to define meaningful contributions that will influence decision making at Stella. 

Job Description:

  1. Responsible to implement Coding Payment Integrity initiatives in collaboration with the Clinical team.
  2. Conduct timely and comprehensive coding audits on claims with concise documentation of decisions and rationale.
  3. Measurement and analysis of performance on initiatives and programs to determine efficacy of the rule and propose and implement changes to reduce false positives.
  4. Case documentation according to regulatory standards.
  5. Facilitate and lead in-depth research and analysis of coding data and processes to identify trends and emerging issues and recommend best practices.
  6. Develop business cases for new coding auditing opportunities.
  7. Provide coding consultation to other teams to assist in their work.
  8. Develop new or revise current reimbursement policies in coordination with the team to educate providers, reduce wasteful spend and to support auditing activities.

Required Qualifications:

  • Bachelor’s Degree and 7 years of relevant medical coding claims experience.
  • 1 of the following active certifications: CPC, CPC-H or CPC-P.
  • Certification (CIC)  and coding/billing experience in institutional/facility claims.
  • Incumbent is expected to enroll in continuing education course to maintain certification.
  • Demonstrated ability to apply critical thinking skills to coding policy interpretations and implementation.
  • Ability to work independently, well-organized and able to set priorities with minimal direction.
  • Demonstrated ability to research analyze and problem solve.

Preferred Qualifications:

Certification (CIC)  and coding/billing experience in institutional/facility claims.

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