Healthcare Coding Specialist – Managed Care Contract Consultant
Sentara is looking to hire a Coding Specialist/Consultant who will be accountable to support coding requirements applicable to hospital, ancillary and physician contracting. This will include identification of appropriate coding for services within provider contracts, monitoring industry code updates and reporting impact to provider contracts, assigning appropriate code categories for each valid CPT/HCPCS code for fee schedule construction, monitoring CMS proposed/final rules for Medicare reimbursement changes and analyzing provider code requests during negotiations. This position is also accountable for assisting in reimbursement policy coding requirements to support reimbursement strategy for the organization.
- CCS (preferred) or CCS-P certification from AHIMA
- COC/CIC (preferred) or CPC certification from AAPC
- 3+ years coding experience using ICD-10-CM/PCS, CPT and HCPCS coding systems
Communication, Critical Thinking, Microsoft Office, Reading Comprehension, Speaking, Technology/Computer, Time Management, Writing
* Consultant will provide financial support in the analysis of managed care agreements, utilization, trend, payer/product membership and data drill downs. This includes identification of trend drivers, payer market share, contract performance, estimated net revenue, and performance in commercial value-based payment arrangements. Will be responsible for analyzing, reporting and developing recommendations on data related to multiple, varied business metrics.
• CCS (preferred) or CCS-P certification from AHIMA
• COC/CIC (preferred) or CPC certification from AAPC
Required: Data Analysis – 5 years, Financial Analysis – 5 years
Preferred: Managed Care Contracting – 3 years
Licenses and Certifications : None, unless noted in the “Other” section below
Other : 5 years data analytics, or 5 years related experience, which is experience in broad based analytical, managed care payer, financial analysis or provider environment. Considerable experience in statistical analysis and/or healthcare modeling. HFMA: Certified Health Care Finance Professional (CHFP) or Certified Specialist Managed Care (CSMC) preferred
Instructions for Resume Submission:
Please forward resume to Lisa Senkowski, Clinical Recruiter at