Coder Analyst

Sioux Center Health; Sioux Falls (SD); On-site; USD 39,000 - 58,000; Full time

Benefits offered by this job

PTO day 1 for eligible hires

Employer retirement matching up to 5%

Career development and mentorship

Job summary

Avera Health is seeking a qualified coder/auditor to coordinate National Coverage and Local Coverage Determination policies, and manage medical necessity activities across payers and Medicare references. The role involves policy validation, staff education, reporting, and supporting payment integrity efforts.

Responsibilities include coordinating LCD/NCD policy implementation, presenting to staff, reviewing ABN processes, and collaborating with coding teams to ensure compliant, efficient claim

Qualifications

• Must be able to perform essential job functions with visual acuity and effective communication.
• AHIMA certifications within 180 days are required or preferred.
• Strong understanding of coding guidelines and medical necessity concepts.
• Ability to collaborate with multiple departments and stakeholders.

Responsibilities

• Establish goals for processing LCD and NCD policies and communicate to departments.
• Assist coders/managers with software inconsistencies for LCD/NCD policies.
• Present information to staff on LCDs/NCDs and coordinate related activities.
• Review Medicare ABN processes and update forms and pricing as needed.
• Serve as liaison for training on front end medical necessity tools.
• Reconcile edits in eProvider Solutions for accurate claims.
• Communicate trends to CDM team and adjust codes when needed.
• Collaborate with coders/managers to streamline front/back end processes.
• Stay current with payer guidelines and regulatory references.

Skills

Communication

Attention to detail

Team collaboration

Problem solving

Education

CCA (AHIMA)

CCS-P (AHIMA)

CCS (AHIMA)

RHIA (AHIMA)

RHIT (AHIMA)

Job description

Pay Range

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$28.00 - $41.75

Location

Avera Health

Worker Type

Regular

Work Shift

Day Shift (United States of America)

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Accountable to coordinate National Coverage and Determination (NCD) policies, Local Coverage Determination (LCD) policies, coverage policies for various payers and Medicare articles and any other activities related to medical necessity throughout Avera. Coordination of medical necessity activities includes: implementation of policy validation processes, education to departments on medical necessity guidelines, running reports for coverage review of new or existing policies, supporting appeals process, streamlining workflow for medical necessity, serving on committees, and other duties as necessary.

What You Will Do

• Establish goals for processing, researching and problem solving new, modified and deleted LCD and NCD policies as well as communicating essential information to appropriate departments and staff.
• Support coders/managers with software application inconsistencies for LCD/NCD policies by communicating with vendors and hospital leaders as necessary.
• Provide presentations to staff as necessary for information pertaining to LCDs/NCDs. Responsible to collaborate and coordinate activities related to Medicare LCDs and NCDs.
• Review Medical Necessity ABN process and other Notices of Non-Coverage forms annually, and more often as necessary, to ensure most recent forms are supported and prices are aligned within parameters regulated by Medicare and other payers.
• Serve as liaison for employee training on front end medical necessity tools such as installations, on-going education, proper functionality, and creation of new pick lists as necessary.
• Reconcile, track and trend edits through eProvider Solutions (ePS) Medical Necessity edits for correct processing of claims on various patient types and eliminate inefficiencies when possible.
• Communicate with CDM team on any trends identified that require adjustments to code assignment in the chargemaster and provide updates as necessary to support compliance.
• Collaborate with coders/managers on front end medical necessity edits that could impact back end edits to work towards a more streamlined approach for process improvement for accurate coding and claim submission.
• Review and keep informed of billing and coding edits relevant to this position such as regulatory guidelines and keeping current with payer specific references such as the Medicare Administrative.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, Or Work Experience

• Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA) within 180 Days or
• Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) within 180 Days or
• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) within 180 Days or
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) Ranked by preference. within 180 Days or
• Registered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) within 180 Days

Preferred Education, License/Certification, Or Work Experience

• Associate's in Health Information Technology
• Bachelor's in Health Information Administration
• 1-3 years of coding experience

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].