Benefits Coding Analyst

Overview Sentara Health is looking to hire a Remote Benefits Coding Analyst. This position is remote, however candidates must be able to commute to our Richmond, VA location. The Benefits Coding Analyst – Certified Professional Coder maintains the integrity of the plan benefits for each program and is responsible for developing an extensive expertise of all plan benefits. The analyst works closely with multiple teams across the Health Plan, including Claims, Compliance, Program, IT, and Health Services/Medical Management to ensure benefits are compliant with state and Federal guidelines and aligned with Program benefit offerings. Responsibilities include synthesizing input from multiple stakeholders to inform significant business decisions regarding benefit implementation, coordinating and maintaining benefit design documentation, researching, coding, and assisting with the development of benefit and utilization review policies and criteria for emerging treatments, technology, medications, and health plan services, and research code updates, authorization requests, and claim questions to update business rules and benefit repositories as appropriate. City/State Richmond, VA Work Shift First (Days) Education Associate Degree in Healthcare (preferred) Certification Certified Professional Coder certification (CPC) (required) Certified Inpatient Coder (CIC) (preferred) Medical Assistant Certification (preferred) Note: CIC is required for advancement to Level 2 and Level 3. Experience 2+ years of medical coding or billing experience specifically within reimbursement, coding, claims processing, claims auditing and/or various payment methodologies (required) Experience in both established benefit coding environments as well as determination of coding requirements for new benefits (preferred) Experience resolving billing and claims issues related to benefit to code assignment Thorough knowledge of anatomy and medical terminology Expertise with NCCI (National Correct Coding Initiative) guidelines Knowledge or direct experience processing Government program or commercial health claims for an MCO Experience with ICD-10 CM, CPT, HCPCS, QNXT Benefits: Caring For Your Family and Your Career Medical, Dental, Vision plans Adoption, Fertility and Surrogacy Reimbursement up to $10,000 Paid Time Off and Sick Leave Paid Parental & Family Caregiver Leave Emergency Backup Care Long-Term, Short-Term Disability, and Critical Illness plans Life Insurance 401k/403B with Employer Match Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education Student Debt Pay Down – $10,000 Reimbursement for certifications and free access to complete CEUs and professional development Pet Insurance Legal Resources Plan Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met. Equal Opportunity Employer Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco‑free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. #J-18808-Ljbffr Sentara Health