Certified Professional Medical Coder; Hybrid - Troy, MI

Project Coordinator - Medical Policy UMC Coder (Hybrid - Troy, MI)

As an integral member of the HAP Medical Policy Team, the Project Coordinator researches and guides coding such as CPT, HCPCS, and ICD, supporting the development and maintenance of the Benefit Administration Manual and the Master Tiering Database. The role also actively participates in code‑related committees and ad‑hoc projects.

• Conduct research for the development and update of codes for the Benefit Administration Manual and the Master Tiering Database, requests by the Utilization Management Committee and HAP code‑related committees, and other issues such as new technology; maintain organized documentation of findings from research as well as proposed resolutions.
• Research all types of codes (e.g., CPT, HCPCS, ICD) including new codes, existing codes, additions and deletions of codes, use of modifiers, and revenue codes to be compliant with Medicare rules and regulations, the Medicare Billing Manual, the American Medical Association, or any adopted resource used in Benefit Administration Manual policies and the Master Tiering Database as needed and on a quarterly or yearly basis.
• Assist with preparing draft Benefit Administration Manual (BAM) policies with correct codes ensuring that all Medicare covered codes are found on the BAM, new codes are on the correct BAM, and codes are aligned with benefit coverage and contractual obligations.
• Participate in Medical Policy Team and HAP code‑related committee meetings to resolve coding questions related to claims, configuration, benefits, new technology, fraud, compliance, and any other issue. Aside from committee meetings, assist with claims resolution issues as needed.
• Assist in requesting and tracking any system configuration changes completed by the Benefit Configuration Team (BCT) and work with BCT on coding changes approved by the Utilization Management Committee or leadership.
• Work with the Medical Policy Team on communications issues related to compliance, billing, new procedure codes, or other matters for inclusion in interdepartmental documents.
• Provide ad hoc research and guidance for special projects as needed.
• Maintain/enhance professional and technical knowledge through educational workshops and reviewing professional publications as it pertains to Benefit Administration Manual policies, claims processing decisions, and coding credentials.

• Associate degree required in Health Information Management (HIM), Health Information Technology (HIT), healthcare, health service, or public health related field.
• Bachelor’s degree or equivalent work experience in healthcare, health service, or public health related field, highly preferred.
• At least three (3) years of coding experience/proficiency in diagnostic and procedural coding, required.
• Wide range of prior coding experience working with both physicians/medical groups/physician offices and hospitals, preferred.
• Strong knowledge of ICD-10-CM coding and guidelines.
• Knowledge of medical billing and third‑party payer regulations.
• Knowledge of CMS programs, processes, risk adjustment payment methodology, and payment principles.
• Knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems.
• Experience with computer software programs such as Microsoft Office products, Adobe Pro, and other data collection tools.
• Excellent quantitative, analytical, and problem‑solving skills and ability to organize and manage multiple priorities.
• Excellent written and oral communication skills, ability to collaborate with multiple HAP departments, and work independently to achieve desired results.

• Certified Professional Coder (CPC) required;
  Certified Coding Specialist (CCS) and/or Certified Coding Specialist‑Physician (CCS‑P) highly preferred.

This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job‑related duties beyond those explicitly described above.

• Organization: HAP (Health Alliance Plan)
• Department:
  Medical Policy
• Henry Ford Health
  
  Location:
  
  HAP (Health Alliance Plan)
• Shift: Day Job
• Union Code:
  Not Applicable

• Associate

• Full‑time

• Other

• Hospitals and Health Care
• Insurance
• Wellness and Fitness Services