Claims Coding Specialist

Samaritan Health Services; United States; Remote; USD 50,000 - 80,000; Full time

Job summary

Join a forward-thinking organization dedicated to building healthier communities. As a coding expert, you will provide critical coding expertise to the Claims Department, focusing on ICD-10 PCS and diagnosis coding. This remote role requires strong communication and problem-solving skills, with a commitment to collaboration across all organizational levels. Ideal candidates will have a Bachelor's degree, a Certified Coder credential, and at least two years of coding experience. Embrace an opportunity to make a significant impact in the health insurance field while working from the comfort of your home.

Qualifications

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

Responsibilities

• Provides coding expertise and interpretation to the Claims Department.
• Offers guidance on ICD-10 coding as it relates to contractual pricing methodologies.

Skills

ICD-10 Coding

Communication Skills

Problem-Solving Skills

Education

Bachelor's Degree

Certified Coder Credential

Tools

FACETS

Job description

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 different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

Candidates residing out of state will need to 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, or Wisconsin.

Job Summary/Purpose

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

Experience/Education/Qualifications

• Bachelor's degree or equivalent experience in a related field required.
• Certified Coder credential from a recognized coding association required.
• Experience and/or training in project coordination required.
• Minimum of two (2) years coding experience required.
• Experience or training in the insurance industry, claim workflows, contract/system auditing, and health information systems (including FACETS) preferred.

Knowledge/Skills/Abilities

• Strong written and verbal communication skills for group presentations, issue discussions, and documentation. Ability to collaborate across all levels of the organization and facilitate effective communication.
• Problem-solving skills, including reviewing information, creative thinking, evaluating options, and implementing solutions.

Physical Demands

• Rarely (1-10%)
• Occasionally (11-33%)
• Frequently (34-66%)
• Continually (67-100%)