Beacon Laboratory Benefit Solutions (BeaconLBS) is a Lab Benefits Management company providing solutions to Health Plans to help them manage the increasing costs of laboratory testing. Through technology, we assist health plans in lowering test costs while improving test and lab-facility selection. BeaconLBS is a wholly-owned subsidiary of Laboratory Corporation of America (LabCorp). Additional information is available at www.beaconlbs.com.
BeaconLBS is seeking a Clinical Coder Analyst. The Clinical Coder Analyst collaborates cross-departmentally, and has interaction with Product Development, IT, Lab Network Management, and Operations. The Clinical Coder Analyst plays a critical role in the content development and maintenance process of clinical coding content. This position reports to the Sr. Vice President of Operations and Technology, the analyst will facilitate the development, maintenance, QA, and delivery of the medical coding policies and claims pathways. In addition to content development, the analyst will be responsible for maintaining clear and concise documentation of all pathways algorithms, recommendations, and supporting data.
The Clinical Coder Analyst provides clinical coding input to certain activities including but not limited to, the creation and translation of clinical rules to the lab benefit management application, mapping of laboratory test codes, creating clinical SOPs, providing coding recommendations during the test mapping process and the Business Requirement story writing in support of claims editing functions and developing coverage policies. The Clinical Coder Analyst also assists clients and lab partners with marketing and communication, operational readiness activities, and on-boarding activities.
Interested? Submit your resume and apply here.
Specific responsibilities follow:
- Responsible for researching, developing and maintaining policies and data sets for Medicare, Medicaid, and Commercial lines of business.
- Ensure adherence to all CMS Claims Processing Legislative and Regulatory requirements including ancillary governmental agencies and professional organizations recommendations.
- Manage development and maintenance of clinical coding content with Team Leads including development of policy rules.
- Support on-boarding and operational readiness of Network Labs.
- Support implementation and operational readiness for Claims Editing / Pricing platform.
- Support other activities for BeaconLBS including analyze data, create and deliver presentations, provide input into system/product strategy, report statuses and issues to senior management, manage and resolve issues, and meet client commitments.
- Ability to comprehend, interpret, analyze, and communicate clinical and laboratory data, including but not limited to ICD10, CPT codes, LOINC, and SNOMED.
- Works with national organizations on CPT related processes (including the American Clinical Laboratory Association (ACLA), American Medical Association (AMA), Centers for Medicare and Medicaid Services (CMS), special MAC or commercial insurance organizations and other organizations related to CPT coding and/or Pathology and Laboratory testing).
- Maintain current knowledge of CPT codes and all related issues including unique carrier requirements for CPT coding of specific procedures or types of procedures. Researches and analyzes coding and payer specific issues relating to CPT coding.
- Serves as CPT coding resource for Product Development, IT, Lab Network Management, and Operations.
- Provides written and/or verbal communication of the rationale(s) of CPT coding determinations or AMA/CMS intent of coding as applicable to company procedures.
- Conduct special projects/studies; participates in various work groups upon request.
ADDITIONAL SKILLS REQUIREMENTS
- Demonstrate clear and articulate verbal, written, and presentation skills with good command of the English language
- Ability to manage multiple initiatives and collaborate cross-functionally
- Self-starter/self-motivated, detail oriented, capable of meeting deadlines, works independently to pursue solutions with minimal direction
- Vigilant and diligent in researching laboratory billing practices for Medicare, Medicaid and commercial lines of business in the marketplace.
EDUCATION AND EXPERIENCE
- Bachelor’s degree or related experience in an insurance or related field
- Minimum five (5) Years of claims, insurance or health care compliance required.
- Professional Coding Certification, specifically CPC or CCS, desired
- Certified Risk Coder (CRC) or additional coding certification(s) desired
- Working knowledge of CMS regulatory requirements related to laboratory services.
- Working knowledge of health plan or laboratory claims processing workflow including HCPCS/CPT, ICD10, LOINC, and SNOMED codes covered for place of services 11, 19, 22, and 81 and bill types 13x and 14x.
- General understanding of laboratory billing practices including 5010 x12 837 specifications, HCFA-1500, and UB-04 forms.