Medical Coding Specialist

 

WellCare is a leading provider dedicated to government-sponsored health plans such as Medicare, Medicaid, State Children?s Health Insurance Programs and others. Founded in 1985, our team of 2,000 associates, over 25,000 physician partners and 47,000+ pharmacies serve nearly three quarters of a million members across seven states:Connecticut, Georgia, Illinois, Indiana, Florida, Louisiana and New York. The WellCare Group of Companies operates plans under the WellCare, Staywell, HealthEase, Harmony and PreferredOne brands. WellCare most recently launched national stand-alone Prescription Drug Plans (PDPs) under the Medicare Prescription Drug Plan.

 

We are looking to add a Medical Coding Specialist to our WellCare of New York team. If you truly believe in teamwork, consistently demonstrate a high level of integrity and want to be part of a dynamic, growing organization, then this may be the opportunity for you!

 

Job Summary:



Review members? medical records from primary and specialist care providers to verify and ensure appropriate and accurate claims diagnosis data in compliance with CMS and State-specific guidelines.  Make necessary adjustments to claims with complex coding issues.  Discuss coding issues with providers. 

 

Essential Functions:

Review medical records to ensure appropriateness and accuracy of billed services.Identify coding error (e.g., upcoding, bundling/unbundling) and recommend correct coding of medical claims.Discuss complex coding issues with providers; interact with physicians and Business Office to accurately code records for appropriate reimbursement.Codes, abstracts and analyzes inpatient and outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) and codes accordance with regulatory agencies and hospital specific guidelines.Perform chart reviews as assigned.Required to travel to Providers to conduct on-site audits and training.

 



Education/Experience:  2-4 years medical coding experience with a hospital or payer organization. Experience working with health insurance claims payment system.Minimum Bachelor's Degree in related field.Must be certified with active status: Certified Professional Coder (CPC) required, Certified Coding Specialist (CCS) or related degree.Billing expertise in UB92, 1500 and other healthcare services.Expert knowledge of electronic medical records/billing systems and medical terminology and abbreviations.







 

Additional Skills and Requirements:Must be able to effectively communicate verbally and in writing complex coding issues with providers.Must be able to effectively communicate verbally and in writing with other staff in order to manage projects and tasks as well as to promote teamwork, communication, and knowledge transfer.Must be able to communicate technical solutions to management for review and approval both verbally and in writing.Must be able to understand and follow verbal instructions and written polices and procedures to ensure adherence to standards and to instructions from management.Must be able to read, write, speak, and understand English in order to communicate with customers, staff, vendors, and management.Must be proficient with Outlook to use the e-mail, calendar, and task features and for e-mail support.Extensive out of office travel is required; may spend up to 70% of time traveling to physician offices using own transportation.