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. You will also provide coding guidance for benefit configuration in and perform business analysis - writing business requirement documents, processes, policies and procedures and training for the business. This is a key role for SFHP as we continue to meet the continuous regulatory, compliance and healthcare industry changes.
WHAT YOU WILL DO
- Provide accurate and timely system configuration related to Medi-Cal updates on code sets and fee schedules.
- Participate in UAT for application enhancements and upgrades, indetifying defects needing resolution.
- Act as the coding expert (ICD-10, 5010, CPT, HCPCS and Revenue codes) for the organization.
- Maintain code set configuration and recommend best practices.
- 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.
- Communicate coding changes to appropriate departments.
- Document policies and procedures (P&Ps) related to our management of medical codes.
WHAT YOU WILL BRING
- A minimum of three years of medical coding/billing and/or claims processing experience.
- 2 or more years of experience working with health system applications (Claims systems).
- 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.
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 135,000+ 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.