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Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota’s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We’re an organization that’s going places. Be part of a team that cares about you, be part of UCare.
The Coding Specialist will identify and analyze new codes and code changes to ensure smooth and timely implementation. This role will work with Configuration staff to identify opportunities for automation of existing manual claims processes. The Coding Specialist will serve as a subject matter expert for Member Services, PAC and Provider Relations to educate on coding issues and assist in preparation of education materials and identify training opportunities. Research and resolution of complex claims and reimbursement issues are also required of this role. Duties of the Coding Specialist include:
- Develop schedule of code changes. Identify and analyze coding changes as it relates to accurate claims processing. Reduce rework by ensuring timely and accurate interpretation of new codes.
- Identify and analyze ad-hoc coding changes. Ensure timely and accurate implementation and education of Claims, Provider Relations, PAC and Member Services.
- Educate operational areas on basic coding and impacts of coding changes. Serve as a resource for coding and reimbursement questions.
- Assist in the development of training programs and education materials for provider training on coding and complex claims issues. Provide direct education to providers as needed.
- Represent UCare at external professional committees, including Administrative Uniformity Committee technical advisory groups, HCPCS and HECAP. Proactively distribute information as appropriate across departments.
- Serve as professional support and work in collaboration with Medical Directors, Clinical nursing staff, Provider Relations, Member Services and PAC by providing assistance and management in the resolution of complex claims issues.
- Analyze degree of manual intervention in existing claims processes. Work collaboratively with Configuration staff and seek opportunities to increase automation and improve autoadjudication rates.
A professional certified coder designation from an accredited institution is required. Two to three years experience as a certified coder, in a health delivery setting, health insurance or Medicare and/or Medicaid setting is required.
Comprehensive knowledge of CPT, ICD-9 and HCPCS coding, claims payment operations, associated medical terminology and payment methodology is required. Three to five years experience is required in claims operations and code editing software (Ingenix iCES preferred). Excellent verbal and written communications skills, strong analytical and problem solving skills and solid presentation skills are desired.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You’ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis—just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.