Coding & Claims - Coordinator 1

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You must complete all required portions of the application and attached the required documents in order to be considered for employment.  

Department

Design and Covered Services

Job Summary

Job Description
• Reviews and verifies accurate CPT, ICD-10, HCPCS reimbursement between the MCO and Providers
• Prepares and analyzes reports on such topics as number of denied claims, documentation or coding issues, for review by management
• Reviews all documentation assigned for completeness, accuracy, and compliance
• Ensure contract compliance by each managed care organization (MCO), as well as timely and responsive MCO and provider support.
• Provides technical guidance to providers, external stakeholders, and MCOs to improve the reimbursement process and to address Medicaid programmatic issues to lessen provider abrasion.
• Serve as liaison with the MCOs and LDH MMIS, Eligibility and Systems staff to address questions and complaints related to claims issues.
• Maintains knowledge of HIPAA guidelines and regulations.
• Review monthly denied claims reports and provide analysis to provider relations program manager.
• Act as the department resource for coding questions and training
• Review Network Adequacy reports and keep up with CMS guidelines
• Assists with administering the provider independent review process to ensure that claim disputes are resolved in compliance with the requirements and timelines established by Act 349 of the 2017 Regular Legislative Session. 
• Assists with oversight of the medical necessity vendor contract and prepares the agenda, minutes, and data for the required Independent Review Panel meetings.
• Serves as technical lead for the implementation of a provider network adequacy analytics tool.  
• Manages the MCO policy submission process, including operationalizing Act 319 of the 2019 Regular Legislative Session, which includes researching managed care and fee-for-service policies, Informational Bulletins/Health Plan Advisories, and state rule, as well as tracking these policies through the approval process.
• Perform other tasks as directed.

Required Qualifications:

• Bachelor's Degree, or 6 years of professional experience in lieu of degree.
• Excellent analytical skills, effective organizational and time management skills.
• Able to independently initiate communication with stakeholders.

Desired Qualifications:

• Bachelor Degree in Public Health, Community Health or Healthcare Management.
• Minimum 1 year of experience with Medicaid program support or working with insurance/Medicare.  
• Minimum 1 year of experience in reporting and statistical analysis.  
• Working knowledge of provider claims, such as claims submittal requirements, posting payments, recoupments and working denials.  
• Certificate in medical coding (AHIMA or AAPC). 

Required Attachments

Please upload the following documents in the Resume/Cover Letter section. 

• Detailed resume listing relevant qualifications and experience;
• Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
• Names and contact information of three references;
• Diversity Statement (required for all Faculty positions and any Staff position of Assistant Manager and higher).

See Diversity Statement instructions by clicking this link: https://www.uno.edu/careers/diversity-instructions

Applications that do not include the required uploaded documents may not be considered.

Posting Close Date
This position will remain open until filled.

Note to Applicant:

Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials.

  

References will be contacted at the appropriate phase of the recruitment process.

  

This position may require a criminal background check to be conducted on the candidate(s) selected for hire.

  

As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.

The University of New Orleans is an Affirmative Action and Equal Employment Opportunity employer.  We do not discriminate on the basis of race, gender, color, religion, national origin, disability, sexual orientation, gender identity, protected Veteran status, age if 40 or older, or any other characteristic protected by federal, state, or local law.