Nurse UM Medical Coding Consultant

The San Francisco Health Plan (SFHP) is a community health plan providing affordable coverage to low income families residing in San Francisco. We are also the third party administrator for the innovative universal healthcare project, Healthy San Francisco. SFHP was designed for and by the residents it serves – many of whom would not otherwise be able to obtain healthcare. SFHP is dedicated to universal coverage, excellent healthcare quality and access, exemplary service, and supporting the financial viability of the safety net. For more information on SFHP visit www.sfhp.org . POSITION TITLE: Nurse UM Coding Consultant, Clinical Services FLSA STATUS: 1099 Contract, 6 months ESSENTIAL DUTIES & RESPONSIBILITIES Evaluation, recommendation and implementation of the correct CPT and HCPCS codes to ensure accurate benefit configuration for SFHP’s managed care system (QNXT) and the efficient and accurate authorization of services. The Nurse UM Coding Consultant in collaboration with SFHP staff will be responsible for: · Evaluation of Medi-Cal covered and excluded service codes and recommendations for SFHP business processes and benefits configuration. · Evaluation of current services requiring authorization and recommendation for those services that can be safely auto approved. · Evaluation of services that are decided by a simple algorithm, documenting and training licensed and non-licensed staff in the approval of these services. · Collaborate with claims, contracts and IT to develop service groups in QNXT (range or procedure/service codes) for use by the authorization staff. EXPECTATIONS Ensures the privacy and security of PHI (Protected Health Information) as outlined in SFHP's policies and procedures relating to HIPAA compliance. Acts with integrity, honesty and fairness, remaining mindful of the duty of trust SFHP has to it employees, and to its providers, members, and employers. Contributes actively and effectively to team discussions, sharing his/her knowledge and expertise willingly and collaboratively. Provides outstanding customer service to both external and internal customers. Suggests process improvements to streamline and improve SFHP customer service. Models professional behavior/conduct that remains in concert with the SFHP culture and business values. Leads by example whether in group or individual meetings. CORE COMPETENCIES/KNOWLEDGE & SKILL REQUIREMENTS · Unrestricted Registered Nursing License for the state of California At least four years of managed care experience, preferred Certified coder, preferred Experience managing the implementation of an IT project desired. Proficient in MS Word, Excel, Access, and Outlook; good basic computer problem-solving skills. Detail-oriented and self-motivated. Excellent verbal and writing skills. Strong organizational skills, efficient time management and project management skills. Multi-tasking abilities. Ability to handle detailed work, including work with varying types of data, maintaining confidentiality at all times where required or requested. Please apply directly through our career page at http://www.sfhp.org

30d+ ago Monster

San Francisco

Expired

Fee not available

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