Coding Analyst I

The Coding Analyst I for SelectHealth provides general expertise in the areas of all areas of coding (professional, facility (inpatient and outpatient), drug, Durable Medical Equipment (DME), and lab code sets) for highly-regulated, government insurance programs such as Medicare, Medicaid, Affordable Care Act (ACA), Children's Health Insurance Program (CHIP), Federal Employees Health Benefit (FEHB) program, and self-funded plans with unique plan designs, reimbursement, compliance initiatives, regulatory legislation, and billing practices.

This analyst reviews claims and monitors provider appeals including sending correspondence to providers.

Essential Functions

• Reviewing claims (pre-payment) to monitor billing practices and ensure accurate coding and reimbursement based on specific contracts, payment methodologies and state and federal regulations that vary by geography and lines of business
• Ensures review decisions are in line with Employee Retirement Income Security Act (ERISA) standards.
• Logging provider appeals and sends correspondence to providers on submitted appeals.
• Serving as a consultant to various other departments within Select Health and departments within Intermountain Healthcare including physicians and facilities.
• Supporting higher level analysts in their responsibilities and research.
• Maintaining subject-matter expertise and educates providers and staff accordingly.
• Responsible for compliance with all coding regulations for all provider specialties (surgical and non-surgical) and coding methodologies.
• Responsible for compliance with all regulations: State and federal regulations vary by state and line of business.

Physical Requirements

• Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with providers, colleagues, customers, and members that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy.
• Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Benefits We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.