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Medical Coding Education Associate - Payment Integrity

This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

**Carelon Payment Integrity** is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate, and prevent unnecessary medical-expense spending.

The **Medical Coding Education Associate** is responsible for the comprehensive analysis of claims data to generate refined and industry-relevant concepts that govern the prosperity of the company across all business lines and client interactions.

How you will make an impact:

+ Engages with providers and other internal and external stakeholders to ensure proactive collaboration in reviewing coding and documentation guidelines. Examine medical records and various documentation to ensure the precision of code assignment.

+ Researches, validates, and stays abreast of medical coding and billing issues, trends, and changes in regulations and industry standards to recommend concepts.

+ Conducts analyses of claims data to bolster the creation of educational concepts. Launch of education concepts.

+ Provide providers with comprehensive feedback on current year coding guidelines and industry expertise, facilitated through phone and email correspondences to ensure that provider understands coding and documentation guidelines for the applicable concept(s).

+ Execute a detailed review of medical records to confirm whether the documentation justifies the level of service provided. Completion of chart reviews and detailed education provided based on the records received.

Minimum Requirements:

+ Requires an AA/AS degree and a minimum of 4 year of experience working with ICD-9/10CM, CPT, and HCPCS coding; or any combination of education and experience, which would provide an equivalent background.

+ Requires current, valid, active, and unrestrictive RHIA certification as a Registered Health Information Administrator and/or RHIT certification as a Registered Health Information Technician and/or CCS as a Cert Coding Specialist and/or CPC Cert Professional Coder.

Preferred Skills, Capabilities, and Experiences:

+ Proficiency with MS Outlook, Word and Excel.

+ Experience in health insurance reimbursement, medical billing, medical coding, auditing, or health data analytics preferred.

+ Strong oral and written communication skills, excellent analytical and problem-solving skills, strong decision-making skills, ability to manage multiple tasks in a demanding work environment, appreciation of cultural diversity, sensitivity towards target membership population, high energy level, self-motivated, and ability to handle several projects at a time.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.