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**Duties & Responsibilities** :

+ Analyze and interpret health insurance benefits and coverage details to apply appropriate medical codes.

+ Accurately assign procedure (CPT, HCPCS) and diagnosis codes (ICD-10) represent patient services, treatments, copays, and coinsurance

+ Verify coding accuracy to support compliant billing and prevent claim denials and accurate claim adjudication

+ Collaborate with clinical, claims and benefits teams to clarify appropriate claim coverage and denials as published within the plan materials

+ Maintain up-to-date knowledge of coding guidelines, insurance policies, and industry regulations

+ Support audits, compliance checks, and quality assurance initiatives to ensure coding accuracy

+ Provide coding guidance and training for other team members as needed

+ Additional duties as assigned

Minimum Qualifications:

+ Coding certification from either American Academy of Professional Coders (AAPC), Certified ProfessionalCoders (CPC) or American Health Information Management Association (AHIMA)

+ Previous Coding work experience

+ High school diploma or GED from an accredited institution

Preferred Qualifications:

+ 5-10 years of experience in medical coding, with a focus on benefits and insurance-related coding

+ Prior experience with LCDs, NCDs and Medicaid coverage determinations

+ Prior experience with multiple Medicare and Medicaid physician, hospital, AMB Surgery, DME, vaccination Ambulance fee schedules

+ Prior experience with multiple claims scrubbers to ensure coding guidelines are followed

+ Prior experience in a health insurance plan

+ Prior experience in New York Medicaid Insurance Plans

+ Bachelors degree in related field

+ Time management, critical/creative thinking, communication, and problem-solving skills

+ Demonstrated professional writing, electronic documentation, and assessment skills

+ Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills

+ Knowledge of anatomy and pathophysiology medical terminologies

Compliance & Regulatory Responsibilities: See Above

License/Certification: See Above

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.