Allegheny Health Network
Job Description :
Organizes, directs and controls the processes and work queues associated with designated coding area under the direct supervision of the coding manager.
- Monitors and maintains claim edit work queues by assigning claims, determining root cause, and providing education to eliminate future recurrence. (15%)
- Monitors and maintains follow up work queues by assigning claims, determining root cause, and providing education to eliminate future recurrence. (15%)
- Performs all steps necessary relative to hiring, evaluating, coaching, promoting, disciplining, and discharging employees by following established HR policies. (15%)
- Trains and supports coding staff on proper process to resolve claim edits and follow up work queues. (15%)
- Monitors and maintains work queues. Assists with prioritization and resolution of issues with deferred claims to get necessary information for coding. (15%)
- Assists in resolution of problem issues within charge review work queues. (10%)
- Assists coding manager with quality control and productivity. (10%)
- Assists coding manager with scheduling, payroll, work queue assignment, and physician education. (5%)
- Performs other duties as assigned or required.
- 2 years of medical claim resolution experience
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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