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Coding Policy Specialist

Date:  Jan 1, 2022

Any city, UT, US, 99999

Req ID:  7239

We are seeking a talented individual for a Coding Specialist who will be working under the direction of the Director of
 Clinical Policy, the Coding Specialist provides coding subject matter expertise to the Clinical Policy Team. Primary
 responsibilities include: develop coding content standards, liaison with Clinical Services team, maintain expertise in HMS
 clinical and coding review products and processes, SME support for account management and sales teams, internal and
 external education on clinical and coding programs, identify and remediate performance gaps in HMS coding programs,
 develop new ideation and concept briefs for HMS clinical and coding programs. 
Essential Responsibilities: 
- Work in conjunction with the physician team to develop and document clinical and coding content standards. Identify best
 practices in the company or industry and use in standard development. Clinical and coding content standards will drive
 decision-making and documentation for the Clinical Services, Quality and Appeals teams. 
- Work with HR, Training and Education teams to make sure that coding content standards are well understood by all
 levels of the organization. 
- Liaison with leadership of applicable departments to assure that coding content standards are the basis for decisionmaking and documentation performed by the operational teams. 
- Maintain expertise in current HMS clinical and coding program processes, work flows and outcomes 
- Provide primary SME support regarding HMS clinical policy, clinical review programs and processes to account
 management and sales teams for both State and Health plan clients. 
- Meet with clients to explain programs and processes, discuss concerns, identify issues and develop proactive solutions
 to problems that clients may be having or anticipate having with HMS clinical and coding review programs. 
- Participate in review and analysis of existing HMS clinical review programs; identify performance gaps and assist with
 developing plan to improve program performance 
- Generate ideas for new ideation, assist with developing review concepts, concept briefs and scoping analysis and
 documentation as assigned. 
- Support provider centric delivery on HMS programs and policies 
- Assist in developing clinical content for HMS clinical acquisition programs and provide assistance as needed in
 acquisition integration 
- Support industry awareness of HMS as clinical leaders, writing white papers, preparing and/or delivering conference
 presentations, etc. 
Non-Essential Responsibilities:- Performs other functions as assigned 
Qualifications - External
Knowledge, Skills and Abilities: 
- Familiar with principals of coding audit, utilization review and payment integrity programs. 
- Familiar with federal and state regulations and payment integrity industry standards 
- Experience with and/or knowledge of HMS clinical and coding claims review program processes, work flows and
- Proficiency in researching federal and state regulations as well as industry standards from a variety of sources 
- Excellent verbal and written communication skills. 
- Ability to comfortably present HMS programs to client leaders and staff 
Work Conditions and Physical Demands: 
- Primarily sedentary work in a general office environment 
- Ability to communicate and exchange information 
- Ability to comprehend and interpret documents and data 
- Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.) 
- Requires manual dexterity to use computer, telephone and peripherals 
- May be required to work extended hours for special business needs 
- May be required to travel based on business needs 
Minimum Education: 
- Bachelor’s Degree or 10 years of experience in lieu education and experience 
- Required Coding certificate 
Minimum Related Work Experience: 
- 10 years of experience in the healthcare field as a coder or auditor with experience in one of the following areas: 
- Health insurance 
- Client service/business to business, 
- Healthcare policy 
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at
 any time. 
EOE including disability/veteran. 

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