Coder Analyst

Medical Necessity Coordinator

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

Accountable to coordinate National Coverage and Determination (NCD) policies, Local Coverage Determination (LCD) policies, coverage policies for various payers and Medicare articles and any other activities related to medical necessity throughout Avera. Coordination of medical necessity activities includes: implementation of policy validation processes, education to departments on medical necessity guidelines, running reports for coverage review of new or existing policies, supporting appeals process, streamlining workflow for medical necessity, serving on committees, and other duties as necessary.

What you will do

• Establish goals for processing, researching and problem solving new, modified and deleted LCD and NCD policies as well as communicating essential information to appropriate departments and staff.
• Support coders/managers with software application inconsistencies for LCD/NCD policies by communicating with vendors and hospital leaders as necessary.
• Provide presentations to staff as necessary for information pertaining to LCDs/NCDs. Responsible to collaborate and coordinate activities related to Medicare LCDs and NCDs.
• Review Medical Necessity ABN process and other Notices of Non-Coverage forms annually, and more often as necessary, to ensure most recent forms are supported and prices are aligned within parameters regulated by Medicare and other payers.
• Serve as liaison for employee training on front end medical necessity tools such as installations, on-going education, proper functionality, and creation of new pick lists as necessary.
• Reconcile, track and trend edits through eProvider Solutions (ePS) Medical Necessity edits for correct processing of claims on various patient types and eliminate inefficiencies when possible.
• Communicate with CDM team on any trends identified that require adjustments to code assignment in the chargemaster and provide updates as necessary to support compliance.
• Collaborate with coders/managers on front end medical necessity edits that could impact back end edits to work towards a more streamlined approach for process improvement for accurate coding and claim submission.
• Review and keep informed of billing and coding edits relevant to this position such as regulatory guidelines and keeping current with payer specific references such as the Medicare Administrative.

Essential Qualifications The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

• Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA) within 180 Days or
• Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) within 180 Days or
• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) within 180 Days or
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) Ranked by preference. within 180 Days or
• Registered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) within 180 Days

Preferred Education, License/Certification, or Work Experience:

• Associate's in Health Information Technology
• Bachelor's in Health Information Administration
• 1-3 years of coding experience

Expectations and Standards

• Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera's values of compassion, hospitality, and stewardship.
• Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call View phone number on click.appcast.io or send an email to View email address on click.appcast.io.