Project Coordinator - Medical Policy UMC Coder (Hybrid - Troy, MI) - Health Alliance Plan
🔍 Troy, Michigan
GENERAL SUMMARY:
As an integral member of the HAP Medical Policy Team, the Project Coordinator will be responsible for research and guidance on coding such as CPT, HCPCS, ICD used in the development and maintenance of Benefit Administration Manual policies and HAP’s coverage tool (Master Tiering Database) as well as actively participate in various HAP code-related committees and ad hoc projects.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Conduct research for development and update of codes for Benefit Administration Manual policies and the Master Tiering Database, requests by the Utilization Management Committee and HAP code-related committees, and other issues such as new technology. Maintain organized documentation of findings from research as well as proposed resolutions.
- Research all types of codes (e.g., CPT, HCPCS, ICD) including new codes, existing codes, additions and deletions of codes, use of modifiers, and revenue codes to be compliant with Medicare rules and regulations, the Medicare Billing Manual, the American Medical Association, or any adopted resource used in Benefit Administration Manual policies and the Master Tiering Database as needed and on a quarterly or yearly basis.
- Assist with preparing draft Benefit Administration Manual (BAM) policies with correct codes ensuring that all Medicare covered codes are found on the BAM, new codes are on the correct BAM, and codes are aligned with benefit coverage and contractual obligations.
- Participate in Medical Policy Team and HAP code-related committee meetings to resolve coding questions related to claims, configuration, benefits, new technology, fraud, compliance, and any other issue. Aside from committee meetings, assist with claims resolution issues as needed.
- Assist in requesting and tracking any system configuration changes completed by the Benefit Configuration Team (BCT) and work with BCT on coding changes approved by the Utilization Management Committee or leadership.
- Work with the Medical Policy Team on communications issues related to compliance, billing, new procedures codes, or other matters for inclusion in interdepartmental documents.
- Provide ad hoc research and guidance for special projects as needed.
- Maintain/enhance professional and technical knowledge through educational workshops and reviewing professional publications as it pertains to Benefit Administration Manual policies, claims processing decisions, and coding credentials.
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and duties. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described above.
EDUCATION/EXPERIENCE REQUIRED:
- Associate degree required in Health Information Management (HIM), Health Information Technology (HIT), healthcare, health service, or public health related field, required.
- Bachelor’s degree or equivalent work experience in healthcare, health service, or public health related field, highly preferred.
- At least three (3) years of coding experience/proficiency in diagnostic and procedural coding, required.
- Wide range of prior coding experience working with both physicians/medical groups/physician offices and hospitals, preferred.
- Strong knowledge of ICD-10-CM coding and guidelines.
- Knowledge of medical billing and third-party payer regulations.
- Knowledge of CMS programs, processes, risk adjustment payment methodology, and payment principles.
- Knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems.
- Experience with computer software programs such as Microsoft Office products, Adobe Pro, and others used for data collection.
- Excellent quantitative, analytical, and problem-solving skills and ability to organize and manage multiple priorities.
Excellent written and oral communication skills, ability to collaborate with multiple HAP departments, and work independently to achieve desired results.
CERTIFICATIONS/LICENSURES REQUIRED:
- Certified Professional Coder (CPC) required but Certified Coding Specialist (CCS) and/or Certified Coding Specialist-Physician (CCS-P), highly preferred.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.