SIU Medical Coding Specialist; Hybrid

Join to apply for the SIU Medical Coding Specialist (Hybrid) role at Care First Blue Cross Blue Shield
.

• Consult on proper coding rules in value‑based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD‑10 codes.
• Provide input on financial and incentive model consequences; support alternatives to maximize quality payments and risk adjustment.
• Act as a technical resource, coding subject‑matter expert for contract pricing issues; conduct operational analyses to assure compliance and improve efficiency.
• Diagnose coding and billing issues, troubleshoot systems and answer complex questions.
• Develop and refine guides/resources for providers on billing methods to maximize quality and STARs outcomes while protecting payment integrity; interact with provider groups as needed.
• Maintain up‑to‑date knowledge of coding rules and standards.

• Education:
  
  High School Diploma or GED.
• Certification: CCS‑Certified Coding Specialist or Certified Coder (CCS or CPC) from AHIMA or AAPC.
• Experience:
  
  3 years in risk‑adjustment coding, ambulatory coding, or CRC coding in managed care or health insurance industry.
• Preferred:
  Bachelor’s degree in a related discipline; experience in medical auditing, training/education to large groups; revenue cycle management; value‑based reimbursement/contracting models.

• Billing practices for hospitals, physicians, and ancillary providers; contracting and claims processing.
• Medical terminology and coding procedures.
• Excellent written and verbal communication.
• Detail orientation and ability to manage multiple projects.
• Data analysis and presentation skills.
• Proficiency with Microsoft Office products and data‑collection tools.
• Customer‑service orientation and ability to handle challenging customers.

$56,448 – $112,112.

Care First Blue Cross Blue Shield is an Equal Opportunity (EEO) employer.

Please visit our website to apply:

Primarily seated; occasionally walking or standing; uses hands for writing and typing; requires hearing and speaking; up to 25 pounds occasionally lifted.

Must be eligible to work in the U.S. without sponsorship.