Coding Specialist

Apr 11, 2012
Apr 19, 2012
Employment Status
Full Time

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:

  1. 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. 
  2. Identify  and  analyze  ad-hoc  coding  changes.    Ensure  timely  and  accurate  implementation  and  education  of  Claims,  Provider  Relations,  PAC  and  Member  Services. 
  3. Educate  operational  areas  on  basic  coding  and  impacts  of  coding  changes. Serve  as  a  resource  for  coding  and  reimbursement  questions. 
  4. 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. 
  5. Represent  UCare  at  external  professional  committees,  including  Administrative  Uniformity  Committee  technical  advisory  groups,  HCPCS  and  HECAP.    Proactively  distribute  information  as  appropriate  across  departments. 
  6. 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. 
  7. 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.

Similar jobs

More searches like this

Similar jobs