Elite Technical is seeking a certified Medical Coding Analyst! The selected candidate will act as an internal expert to analyze and ensure that value-based reimbursement and medical policy models are developed and implemented, and ahead of trends. We are seeking broad generalist medical coding professionals (not specialists focused) who can provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. The selected candidate will utilize extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity.

This position is a contract opportunity that could lead to a permanent position (no guarantee) with our client. Although 100% remote, we are seeking candidates that reside in one of the follow states: DC, MD, VA, WV, NC, PA, DE, NY, NJ, TX, FL.
Want to learn more? Then you should contact Elite Technical right away for consideration!

Required Skills

-5 years in medical coding analysis related work (required). Seeking candidates that can analyze trends and able to understand why authorizations are not connecting to claims properly. Ability to review data is VERY IMPORTANT. Must be able to review data for code trends, medical policy methodologies, analyze codes for trend purposes. Having analytical skills is critically important across broad medical practices
-Coding certification required - Certified Professional Coder (CPC) is most preferred, Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or similar is A/OKAY
-Understanding of auth to claims process
-Be able to translate regulatory requirements into the auth claims configuration cycle
-Ability to work with all LOBs (Medicare, Caid, Commercial, ASO, etc)
-Detail oriented and strong understanding of CPT code groupings using data and medical understanding

Preferred:
-Claims Adjudication knowledge
-Facets
-GuidingCare (Healthedge platform)