Providence Health & Services Coding Policy Analyst in Portland, Oregon
Providence is calling a full-time, certified, Coding Policy Analyst to Providence Health Plans in Beaverton, OR. This role will join a collaborative team partnering with Medical Directors and Quality Management leaders on maintaining plan-wide policies. This role directly influences how policies are created, and helps to implement new guidelines and technology into payment policy for the Health Plan. If you’re an experienced, healthcare coding professional looking for the next step in your career, we’d love to connect with you.
This position will be primarily based at our Murray Business Center location in Beaverton, OR, with free parking and an onsite gym. Money Magazine recently listed Beaverton among the 10 best small cities to live in America for 2016! There is an option to work remote one to two days per week after the initial six-month training period.
In this position, you will:
Be responsible for the coordination of technically detailed work that has a significant impact on all operations and information systems within Providence Health Plan (PHP).
Assist with edit configuration for PHP claims coding editing system.
Reply to provider and member payment appeals and provide appropriate Current Procedural Terminology (CPT), Centers for Medicare & Medicaid Services (CMS), specialty society, PHP Medical Director review, PHP payment policy, and/or other official documented rationale for upholding denials.
Assist with updating the company’s coding database with new, deleted, and revised codes as these are published throughout the year and informs appropriate parties at PHP when there are changes to this database.
Possess knowledge of CMS, Medicaid, and worker's compensation policies and regulations.
Serve as a resource to other departments within PHP for questions about CPT, Healthcare Common Procedure Coding System (HCPCS), American Society of Anesthesiologists (ASA), and International Classification of Diseases (ICD)-9/10 codes, as well as coding guidelines and regulations.
Work with the Benefits Administration Team and the Regulatory Department to ensure coding edits are applied in a manner consistent with member benefits and all state and federal insurance regulations.
Assist with monitoring changes to codes, coding guidelines and regulations, and coding edits from external agencies such as American Medical Association (AMA), CMS, Medicaid, and specialty societies.
Assist with implementation of such changes to the claims adjudication software and coding editing software as needed.
Required qualifications for this position include:
Bachelor's degree -or- equivalent work experience in healthcare
Certification through American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA)
5 years of experience directly related to Current Procedural Terminology (CPT) coding from chart extraction with a healthcare provider, a health insurance company, or a capitated managed care company
Demonstrated experience in detailed coding applications, as well as Microsoft Office capabilities, such as Excel, Word, and Access
Preferred qualifications for this position include:
- Experience with Facets Claims Adjudication system and clinical editing software
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 76,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 475 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Coding
Req ID: 134522