BlueCross BlueShield of Tennessee Manager Coding Process Improvement in Chattanooga, Tennessee
This position oversees one of the units within the coding and reimbursement research area (CARR) which provides support for contract development, system configuration, code maintenance, member benefits, medical policies, editing, correct coding education, provider disputes, appeals, customer service and claim adjudication as applicable to all lines of BCBST products. Additional responsibilities for this position include the dissemination of new and revised code sets, monitoring the progress of new code implementation across the enterprise, and elevating concerns to senior leadership. Other key responsibilities include an ongoing process improvement effort, along with developing and maintaining appropriate management reporting.
Effective 2/27/17: This Position requires an 18 month commitment before posting for other internal positions.
Job Duties & Responsibilities
- Responsible for managing the end-to-end code implementation and update process. This includes communication of coding changes to all appropriate parties, coordinating and chairing meetings with those parties on an ongoing basis to monitor and guide the process for all divisions, and report any issues or delays to senior leadership.
- Spearhead the process to develop and implement the analytical tools to monitor and report the activities of the entire CARR area. Actively lead efforts within the CARR area to reduce the volume of unnecessary or redundant inquiries from the Claims and Service areas.
- Create, implement and maintain a central repository for codes that can be utilized throughout BCBST to identify codes and is a “source of truth” for the appropriate relevant data
- Create summary reports for division and corporate leadership that accurately reflect the actions and volumes of the CARR area.
Participate with the other CARR managers in managing the evaluation, development, implementation and maintenance of:
Coding policies and procedures in accordance with industry standard coding conventions to support provider billing, contracting, adjudication, and reporting efforts
- Code editing (i.e. code bundling, global periods, gender age, diagnosis/gender, diagnosis procedure edits) rules as published by National Correct Coding Initiative (NCCI) and other recognized industry standards.
- Prepares and adheres to the budget for department cost center
- Maintains proficient knowledge and ensures corporate compliance with HIPAA Administrative Simplification Medical/Clinical Code Sets and industry recognized code editing rules
- Supports the review, prioritization, and approval of code editing changes based on National Correct Coding Initiative (NCCI) and other recognized industry coding standards.
- Serves in an advisory capacity regarding coding, reimbursement, and billing issues Serves as a liaison between BCBST, BCBSA, BCBS plans, Centers for Medicare and Medicaid Services, Medicare Carriers/Fiscal Intermediaries, American Medical Association, American Dental Association, Tennessee Medical Association, Tennessee Hospital Association and providers regarding coding/billing issues
- Detects and reports potential provider coding education opportunities and potential provider fraudulent/aberrant billing practices to Provider Audit and/or Special Investigations Unit
- Other duties or responsibilities assigned by Management
- Overnight travel may be required
- Bachelor's degree in nursing, health information management or related health care field or equivalent work experience is required.
- Master’s degree in nursing, health information management, or related health care field is preferred.
- Active Tennessee nursing licensure is preferred.
- Minimum of 5 years’ experience with medical/clinical coding (i.e. CDT-Current Dental Terminology, CPT-Current Procedural Terminology, HCPCS-Healthcare Common Procedure Coding System, and ICD-International Classification of Diseases) is required.
- Minimum of 3 year’s leadership/supervisory experience is required.
- Project management experience including coordinating cross-functional activities is required.
- Coding certification from a nationally recognized coding organization (i.e. American Academy of Professional Coders-CPC or CPC-H certification, American Health Information Association CCS-P or CCS certification) is required.
- Proficient knowledge and understanding of Health Insurance Portability and Accountability Act (HIPAA) standardized claims transaction and medical/clinical code sets is required.
- Proficient knowledge and understanding of BlueCross BlueShield of Tennessee provider reimbursement methodologies is preferred
- Proficient knowledge and understanding of Medicare provider reimbursement methodologies for all specialty areas is required
- Proficient knowledge and understanding of Microsoft Office (i.e. Word, Excel, Access, and PowerPoint) is required.
- Proficient knowledge and understanding of claims, customer service, member benefits, authorization, and provider reimbursement applications and configuration is preferred.
- Proficient knowledge and understanding of the Burgess Reimbursement System is preferred.
- Proven problem solving abilities, strong analytical skills, initiative, ability to work independently, and ability to coordinate department assignments and strategic cross-functional/multi-divisional initiatives is required.
- Must be well organized and have experience in managing multiple assignments with critical deadlines.
- Excellent human relations and communications skills (both verbal and written) are essential.
Job Specific Requirements:
Grade 12 BBEX
Incentive Plan T70210 EX/CAP - Grd 12 & Und
Number of Openings Available:
BCBST BlueCross BlueShield of Tennessee, Inc.
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or membership in a historically under-represented group.
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
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To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products in any form in Tennessee and where state law permits. A tobacco-free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a tobacco/nicotine test. An individual whose test result is positive for tobacco/nicotine will be disqualified from employment and the job offer will be withdrawn. Individuals who fail the tobacco/nicotine screening will be permitted to reapply for employment after 6 months, if tobacco/nicotine-free.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.
As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.