Are you looking to make an impact on the community and grow your skill set in a managed care arena?
As SFHP's Medical Coding Analyst, you will support all areas of SFHP and be responsible for ensuring that the core administrative systems are configured accurately and kept up-to-date for medical coding in compliance with regulatory standards. You will also provide coding guidance for benefit configuration in consultation with the Utilization Management, Contracting and Claims Departments. This is a key role for SFHP as we continue to meet the continuous regulatory, compliance and healthcare industry changes.
WHAT YOU WILL DO
• Act as the coding expert (ICD-10, 5010, CPT, HCPCS and Revenue codes) for the organization.
• Drive reinsurance and reimbursement activities, such as the Rate Development Template (RDT) process.
• Participate in major code change projects and maintenance.
• Interpret existing and new medical codes, ensuring they are all accurately set-up and maintained in core systems.
• Review, research, and interpret publications, bulletins, and provider manuals from external sources to ensure that all coding information and updates are captured in core systems.
• Participate and interact actively with the Contract, Claims, Configuration, Compliance, and Health Services teams.
• Coordinate system changes related to Medi-Cal updates, participates in business UAT and obtains approvals for go-live.
• Leading the Code Maintenance work group, a cross functional forum focused on addressing ongoing coding updates and issues to ensure compliance.
• Communicate coding changes to appropriate departments.
• Document policies and procedures (P&Ps) related to our management of medical codes.
• Maintain and update content for monthly Medical Coding Newsletter.
WHAT YOU WILL BRING
• Minimum of three years of medical coding /billing and/or claims processing experience.
• BA/BS degree, preferably related to health care or business or equivalent work experience.
• Expert knowledge of ICD-9, ICD-10, CPT, HCPCS and Revenue codes.
• Medical Coding Certification (AAPC or equivalent) preferred.
• Prior experience at a healthcare organization, particularly at a managed health plan.
• Experience with Microsoft Excel, particularly Pivot Tables and basic use of formulas.
• Knowledge of managed care and Medi-Cal reimbursement.
• Demonstrated depth of knowledge and experience in medical claims procedures, processes, governing rules and all aspects of claims adjudication.
• Solid understanding of standard claims processing systems and claims data analysis.
• Working knowledge of medical terminology.
• Superior interpersonal, written and verbal communication skills.
• Prior experience documenting business requirements, policies and procedures, user training and report specifications.
• PC literacy; MS Office skills (Outlook, 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.