Policy Coding and Enforcement Analyst
The Policy Coding and Enforcement Analyst will work closely with Medical Policy and Configuration Management to ensure proper coding and translation of medical policies into enforcement rules to implement within the automated claims editor.
This position is eligible for remote work, but quarterly travel will be required to the corporate office located in Tampa, Florida.
Policy Coding and Enforcement Analyst - Essential Functions and Responsibilities:
Review each Medical Policy to identify necessary coding and enforcement updates
Apply proper ICD-10, CPT, and HCPCS coding to Medical Policies
Develop Medical Policy enforcement rules, including rationale for interpretation, supporting evidence, and documentation, from Medical and Payment Policies
Identify and record coding and enforcement changes for each policy
Perform coding and enforcement analysis and research as needed
Policy Coding and Enforcement Analyst Minimum Qualifications:
Bachelors degree in biology, chemistry, medicine, nursing, medical technology, or related field or equivalent related work experience
Minimum 5 years work experience
Coding certification: RHIT, CPC, CCS or similar
Clinical experience with a background of ICD-10, CPT, and HCPCS coding principles
Experience with developing claim editing and enforcement rules
High attention to detail, including proper documentation
Strong understanding of laboratory billing and reimbursement practices
Strong verbal and written communication skills with the ability to simply convey complex subject matter
Independent, capable of decision making with limited information
Policy Coding and Enforcement Analyst Preferred Qualifications:
Certified Medical Coder - RHIT, CPC, CCS or similar
Configuration experience edit building or testing
Knowledge of and experience with laboratory medical coding rules and regulations, compliance, and reimbursement
Experience with Centers for Medicare & Medicaid Services (CMS) and industry standard billing, compliance, and reimbursement methodologies
Familiarity with commercial payor medical policies
Familiarity with government programs, such as Medicare and Medicaid
Experience with data analysis tools
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