Manages claims coding rule process. Evaluates claims coding rule change request from clinical, financial, and claims operations perspectives. Provides regulatory and correct coding research on change requests and makes recommendations on correct payment policy and edit functionality. Defines requirements and partners with vendors throughout testing and implementation. Supports provider dispute/appeal team.

　　Manages research of claims coding rule initiatives including the development of detail work plans.

　　Receives and logs requests of changes for tracking purposes.

　　Maintains a library of all the existing and retired rules, the source of the rule and the implementation/retire date of the rule (by Group/Plan/Division).

　　Documents supporting authority for each claim coding rules by Group/Plan/Division (Master Grid).

　　Participates in cross-functional teams to address key claims coding rule issues facing the organization.

　　Administers communication to Network and collects feedback.

　　Evaluates change proposal from a regulatory perspective, financial perspective, and claims operational perspectives.

　　Seeks professional feedback from Health Services, Finance, and Claims on claims coding rule changes.

　　Identifies coding error (e.g., upcoding, bundling/unbundling) and recommends correct coding of behavioral health claims.

　　Research state laws and CPT/AMA guidance.

　　Presents change proposals.

　　Communicates effectively to network.

　　Develops relationship with claims coding rule software vendors.

　　Receives, researches, and determines appropriate action steps for escalated provider disputes from Dispute/Appeal team, Claims, and Network.

　　Support Claims, Configuration, and/or Dispute/Appeal teams as necessary.

　　Manages high visibility projects and provides recommendations and status to Leadership.

　　Acts as the first point of contact in dealing with day to day business issues and support for problem resolution.

　　Researches, analyzes, and presents savings opportunities to Leadership

　　Perform other duties as assigned.

　　Other Job Requirements

　　Responsibilities

　　5+ years of experience in the medical coding field with a facility, provider, or payer organization.

　　Associate degree required. A combination of education and experience may be considered.

　　Knowledge of CMS/State laws and AMA guidance.

　　Advanced user and knowledge of claims payment system.

　　Knowledge of 3M Encoder

　　Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations.

　　Billing expertise in UB92, 1500 and other healthcare services.

　　Knowledge of one or more of the following: SQL, Xcelys, CES, iHT

　　Demonstrated written communication skills.

　　Demonstrated leadership skills.

　　Demonstrated interpersonal/verbal communication skills.

　　Ability to work as part of a team.

　　Demonstrated problem solving skills.

　　General Job Information

　　Title

　　Senior Coding Research Analyst

　　Grade

　　24

　　Work Experience - Required

　　Claims

　　Work Experience - Preferred

　　Education - Required

　　A Combination of Education and Work Experience May Be Considered., Associate, GED, High School

　　Education - Preferred

　　License and Certifications - Required

　　CCS - Certified Coding Specialist - Enterprise

　　License and Certifications - Preferred

　　Salary Range

　　Salary Minimum:

　　$58,440

　　Salary Maximum:

　　$93,500

　　This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

　　This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

　　Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

　　Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.

　　Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.

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