In this organizationally critical role, you will be responsible for ensuring that the core administrative systems are configured accurately and kept up-to-date for medical coding. You provide coding guidance for benefit configuration as well as for the Utilization Management, Contracting and Claims Departments. You will utilize your analytic accumen to take part in business analysis and provide valuable input to those who will create business requirements, processes, policies and procedures as well as training for the business.
WHAT YOU WILL DO
- Act as a medical coding resource (ICD-9, ICD-10, 5010, CPT, HCPCS and Revenue codes) for SFHP.
- Be a key participant in major code change, code review, and code audit projects.
- Interpret existing and new contract codes, ensuring that codes are accurately set-up on all systems.
- Coordinate system changes related to Medi-Cal updates and participate in user acceptance testing, obtaining approvals for go-live.
- Update policy and procedure documents related to our management of medical codes and provider configuration.
- Perform provider configuration for in-network and out-of-network providers.
- Provide your coding expertise to any provider configuration inquiries.
- Deliver periodic training to new staff on provider configuration.
WHAT YOU WILL BRING
- Bachelors degree, preferably related to health care or business, or equivalent work experience.
- Minimum of two years of prior claims processing and/or medical billing experience preferred.
- Medical Coding Certification (AAPC or equivalent) preferred.
- Demonstrated experience with ICD-10, CPT, HCPCS and Revenue codes.
- Knowledge of managed care and Medi-Cal reimbursement.
- Demonstrated depth of knowledge and experience in medical claims procedures, processes, governing rules and claims adjudication.
- Solid understanding of standard claims processing systems and claims data analysis.
- Superior interpersonal, written and verbal communication skills.
- Demonstrated attention to detail and problem solving skills.
- Prior experience at a healthcare organization, particularly at a managed health plan.
- Strong MS Office skills (Word, Excel, PowerPoint).
Established in 1997, San Francisco Health Plan (SFHP) is a an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 145,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.