CARR Analyst II

CARR is seeking a Coding Analyst II to support the Facility Coding & Reimbursement Team! This role supports facility coding and reimbursement across all lines of business, including contract development, system configuration, code maintenance, medical policy implementation, claim editing, provider disputes, appeals, coding updates, and claims adjudication. In this position, you will research complex coding and reimbursement issues, evaluate regulatory and industry changes, and collaborate with Claims, Provider Network Management, Medical Policy, Clinical Coding Review, IT, and Customer Service to support payment accuracy, compliance, and reimbursement solutions. Our ideal candidate will bring: Experience in facility coding and reimbursement, including inpatient and outpatient payment methodologies Experience with claims processing, reimbursement research, regulatory guidance, claims editing, and payment integrity reviews Strong analytical and problem-solving skills with the ability to research and communicate complex reimbursement topics Additionally, knowledge of MS-DRGs, APCs, revenue codes, facility billing requirements, contract reimbursement methodologies, and payer reimbursement systems is strongly preferred. Note: Sponsorship is not available for this role. Job Responsibilities Responsible for the research, design, analysis, recommendation, implementation, problem resolution, maintenance and coordination of coding and reimbursements. Researches and prepares coding and reimbursement policies and procedures and billing guidelines. Coordinates data collection and administrative functions for the implementation of coding, reimbursement, and billing changes; serves in an advisory support capacity regarding coding, reimbursement, and billing issues on various corporate committees, workgroups, and/or sub-workgroups. Assists in the development of educational material to be used for training staff. Provides coding consultations to support company administrative functions and reviews, prioritizes, prepares, and presents recommended code editing changes. Job Qualifications Education Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment Experience 3 years - Experience with Medical/Clinical Coding Skills\Certifications Coding certification from a nationally recognized coding organization (i.e. American Academy of Professional Coders-CPC or CPC-H certification, American Health Information Association CCS-P or CCS certification) is required. If not Coding certified, must be willing to obtain certification within two years of being hired in the position. Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint) Must be a team player, be organized and have the ability to handle multiple projects Excellent oral and written communication skills Strong interpersonal and organizational skills Knowledge and understanding of claims, customer service, member benefits, authorization, and reimbursement applications and configuration. Knowledge and understanding of BlueCross BlueShield of Tennessee and Medicare provider reimbursement methodologies for at least one of the following specialty areas is required: Professional services, Facility services or Home Health services. Basic knowledge and understanding of Health Insurance Portability and Accountability Act (HIPAA) standardized claims transaction and medical/clinical Number of Openings Available 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.