Claims Coding Specialist, Michigan at McLaren Health Care

Flint, Michigan, United States -

Full Time

Start Date

Immediate

Expiry Date

31 Jan, 26

Salary

0.0

Posted On

02 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Coding, Health Information Management, Analytic Role, Change Management, Reporting, Testing, Business Rules, Federal Guidelines, State Guidelines, Managed Care, HMO, PPO, TPA, PHO

Industry

Hospitals and Health Care

Description

We are looking for a Claims Coding Specialist, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org. MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/. Position Summary: At the direction of the assigned leadership, interprets business rules, federal and state guidelines and prepares specifications for all information systems, including benefiting and pricing requirements for claims processing. Develops and maintains reporting as needed by leadership and operational objectives. Assists in the enforcement of product, reporting and service controls and standards, deadlines, and schedules by creating and maintaining detailed development plans. Defines test scenarios, involved in testing, and approval of testing results for implementation to ensure business requirements are met. Responsible for change management that impact claims configuration for all systems. This position is fully remote. #LI-AK1 Qualifications: Required: · Associate degree in Health Information Management, Applied Science, Business Administration, Health Care Administration or equivalent program with emphasis on coding; or High school diploma with two (2) years of related experience. · Certified Medical Coder (CPC, RHIT or RHIA). · Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions. · Two (2) years’ experience in analytic role utilizing systems and data. Preferred: · Five (5) years of outpatient, professional or inpatient coding experience.

Responsibilities

Interprets business rules and prepares specifications for information systems related to claims processing. Responsible for change management impacting claims configuration for all systems.