Claims Coding Specialist

Samaritan Health Services; Oregon (IL); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a Claims Coding Specialist to provide coding expertise and interpretation within the Claims Department. This remote role requires a strong background in ICD-10 coding and offers the opportunity to guide contractual pricing discussions. Candidates should possess effective communication skills and the ability to analyze complex problems. This position is perfect for those looking to grow in the healthcare sector while contributing to building healthier communities. Join a team dedicated to making a difference in healthcare delivery.

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• Certified Coder credential from a recognized coding association.

Responsibilities

• Provides coding expertise focusing on ICD-10 PCS and diagnosis coding.
• Offers guidance on ICD-10 coding related to contractual pricing.

Skills

Effective communication skills

Problem analysis and solution development

Education

Bachelor's degree or equivalent experience

Certified Coder credential

Tools

FACETS

Job description

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About Samaritan Health Plans

Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several legal structures, including:

• InterCommunityHealth Plans, Inc. (IHN), a regional CCO for Medicaid beneficiaries.
• Samaritan Health Plans, Inc., offering Medicare Advantage, Commercial Large Group, and PPO/EPO plans.
• The third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an integrated delivery system, Samaritan Health Plans aligns with Samaritan Health Services’ mission of Building Healthier Communities Together.

Note: Candidates residing out of state must be able to work Pacific Time Zone hours.

This is a remote position available in the following states: Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin.

Job Summary

Provides coding expertise and interpretation to the Claims Department, focusing on ICD-10 PCS and diagnosis coding. Offers guidance on ICD-10 coding related to contractual pricing and serves as an internal expert on claim qualification for contractual terms.

Experience and Qualifications

• Bachelor's degree or equivalent experience in a related field.
• Certified Coder credential from a recognized coding association.
• Experience and/or training in project coordination.
• At least two years of coding experience.
• Preferred: experience in the insurance industry, claim workflows, auditing contracts, and navigating health information systems like FACETS.

Skills and Abilities

• Effective communication skills for presentations, discussions, and documentation.
• Ability to analyze complex problems, employ creativity, and develop solutions.

Physical Demands

Activities include climbing stairs, lifting up to 20 lbs, bending, kneeling, standing, walking, reaching, pushing, pulling, sitting, grasping, and manual dexterity. Physical activity varies from occasional to continual throughout the workday.

Additional Information

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Healthcare Provider
• Industry: Hospitals and Healthcare

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