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We are looking for a skilled Clinical Consultant to join our team on a long-term contract basis. This position offers an exciting opportunity to support a strategic benefit digitization initiative within the healthcare industry. You will play a key role in implementing standardized coding practices, ensuring regulatory compliance, and contributing to the success of digital transformation efforts.
Job Responsibility:
Apply standardized coding practices to accurately interpret and digitize benefit structures across diverse markets
Develop and maintain groupings of procedures and service codes to align with benefit plans
Manage quarterly and annual updates of industry-standard codes and ensure benefit plan codes are current
Execute coding solutions for both standard and nonstandard benefit requests, addressing stakeholder needs
Ensure compliance with regulatory mandates by updating coding practices as required
Provide expert consultation and respond to inquiries related to benefit coding from project teams and business partners
Collaborate with cross-functional teams to support successful implementation of benefit digitization projects
Offer guidance on coding methodologies and contribute to enhancing member and provider experiences
Support long-term cost management initiatives by leveraging coding expertise in digitization efforts
Requirements:
Certified Professional Coder (AAPC or AHIMA) with focus on CPT/HCPCS outpatient coding
Minimum of three years of experience in coding and reimbursement methodologies, including ICD-10
Proficiency in Microsoft Word, Excel, Access, and PowerPoint at an intermediate to advanced level
Strong analytical skills to translate data into actionable recommendations
Excellent verbal and written communication abilities
Ability to work independently with minimal supervision
Flexible and capable of managing multiple tasks effectively
What we offer:
medical, vision, dental, and life and disability insurance