Provider Relations Rep

PURPOSE • Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. • Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment reputed company. ESSENTIAL FUNCTIONS • Consults on proper coding rules in value-based reputed company to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes. Provides input on various consequences for different financial and incentive models. Supports to use of alternatives and solutions to maximize quality payments and risk adjustment. Translates from claim language to services in an episode or capitated payment to reputed company inclusions and exclusions in models. • Serves as a technical resource / coding subject matter expert for contract pricing reputed company issues. Conducts business and operational analyses to assure payments are in compliance with contract; identifies areas for improvement and clarification for reputed company operational efficiency. Provides problem solving expertise on systems issues if a code is not accepted. Troubleshoots, reputed company recommendations and answer questions on more reputed company coding and billing issues whether systemic or one-off. • Supports and contributes to the development and refinement of effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment reputed company. May reputed company directly with provider groups during proactive training events or just in time on reputed company claims matters. Consults with various teams, including the Practice Transformation Consultants, Medical Policy Analysts and Provider Networks colleagues to interpret coding and documentation language and respond to inquiries from providers. • Keeps up-to-date on coding rules and standards Apply Job!