CARR Analyst II

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Conduct research, design, analyze, recommend, implement, resolve issues, maintain, and coordinate coding and reimbursement processes.

• Investigate and formulate coding and reimbursement policies, procedures, and billing guidelines.

• Oversee data collection and administrative operations related to coding, reimbursement, and billing modifications.

• Provide guidance to corporate committees, workgroups, and sub-workgroups on coding, reimbursement, and billing matters.

• Aid in the creation of educational resources for staff training purposes.

• Offer coding consultations for company administrative functions and evaluations.

• Evaluate, prioritize, prepare, and present suggested code-editing modifications.

• Facilitate coding and reimbursement support across all business lines, encompassing contract development, system configuration, code maintenance, medical policy implementation, claim editing, provider disputes, appeals, coding updates, and claims adjudication.

• Investigate intricate coding and reimbursement challenges and assess regulatory and industry developments.

• Collaborate with Claims, Provider Network Management, Medical Policy, Clinical Coding Review, IT, and Customer Service to enhance payment accuracy, compliance, and reimbursement strategies.

⛳️ Requirements

• Bachelor's Degree or equivalent professional experience is required.

• Equivalent experience is considered to be 4 years of professional work within a corporate setting.

• Minimum of 3 years of experience in Medical/Clinical Coding.

• Coding certification from a recognized national coding organization is mandatory, such as AAPC CPC/CPC-H or AHIA CCS-P/CCS.

• If not already certified, a willingness to obtain certification within two years of employment is necessary.

• Experience in facility coding and reimbursement, including inpatient and outpatient payment methodologies.

• Familiarity with claims processing, reimbursement research, regulatory guidance, claims editing, and payment integrity evaluations.

• Strong preference for knowledge of MS-DRGs, APCs, revenue codes, facility billing requirements, contract reimbursement methodologies, and payer reimbursement systems.

• Ability to research and articulate complex reimbursement subjects.

• Capability to work independently with minimal supervision or as part of a team.

• Proficient in Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint.

• Highly organized and adept at managing multiple projects simultaneously.

• Excellent verbal and written communication abilities.

• Strong interpersonal and organizational skills.

• Understanding of claims, customer service, member benefits, authorization, and reimbursement applications and configurations.

• Familiarity with BlueCross BlueShield of Tennessee and Medicare provider reimbursement methodologies for at least one specialty area: Professional services, Facility services, or Home Health services.

• Basic comprehension of HIPAA standardized claims transactions and medical/clinical coding.

• Sponsorship is not available for this position.

🏝️ Benefits

• Opportunity for remote work in a remote-first organization.

• Potential relocation assistance if residing in Chattanooga, TN is necessary.

• Access to training opportunities.

• Utilization of AI-enabled tools supported by workflows, templates, and policies.