Clinical and Coding Support Coordinator at Zelis Healthcare
Clinical & Coding Support Coordinator
- Position level: Associate
- Working time: Full-time
- Type of contract: Permanent
Description & Requirements
The Clinical & Coding Support Coordinator will primarily be responsible for supporting the Cost Management team specific to Claims Editing. The Coordinator would serve as the liaison and subject matter expert to manage tasks relating to claim review, corrected claims and disputes based on accepted medical necessity guidelines, billing and coding rules, plan policy exclusions, and clinical or payment errors/overpayments. The Coordinator will be responsible for managing any coding or clinical research as needed to achieve greatest possible savings on claims.
- Review and utilize the most up-to-date approved coding and clinical sources to respond to disputes and claim corrections while also advising appropriate personnel of important changes, issues, and trends
- Work closely with the Nurse Auditor staff to manage any claim matters that require Chief Medical Officer involvement
- Assists department in customizing and/or creating dispute letters as needed
- Identifies edit discrepancies based on coding guidelines, coding sources, and/or Zelis processes and make recommendations of updates and changes
- Analyze claim data to support initiatives being managed by the Director, Service Operations
- Work closely with the Zelis research team to perform any applicable research as it relates to claims editing; research nationally recognized sources and information to ensure support of products & solutions
- Identify any tools and/or technologies required to expand products/solutions
- Performs other related responsibilities and special projects as assigned
- Partner with Account Management in any client related matters as needed
- Assist in tracking and monitoring productivity and value with existing and future concepts
- Maintain awareness of and ensure adherence to ZELIS standards regarding privacy
- LPN or RN required
- Coding certification, CPC or CCS, required
- Code Editing experience preferred
- Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
- Understanding of outpatient coding and billing rules
- Excellent written and verbal communication skills
- Highly organized with attention to detail
- Strong analytic skills regarding data requests and reporting
- Clinical skills to evaluate appropriate Medical Record Coding.
Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims. Zelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers’ compensation markets nationwide. Zelis is backed by Parthenon Capital Partners and Bain Capital.
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