About this role
McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a SIU Coder, to join in leading the organization forward.
MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).
MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
Position Overview:
The Special Investigations Unit (SIU) Coder supports lines of business from McLaren Health Plan, Inc., McLaren Health Plan Community, and McLaren Health Advantage (McLaren) and is responsible for performing medical claims and records reviews to assist in investigations, ensuring compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The SIU Coder works in collaboration with a team of SIU Auditors to review records and claims as part of the ongoing audits of the SIU department. The SIU Coder serves as the subject matter expert for all coding activities and collaborates with other departments within McLaren on payment integrity and provider education.
This position is fully remote.
Qualifications:
Required:
Associate's Degree in Health Information Management, Healthcare Business Services, or equivalent program with emphasis in coding or High School diploma with two (2) years of related experience.
Certified Medical Coder (CPC, RHIT, or RHIA).
Two (2) years of hands-on experience in ICD-10-CM and AMA diagnostic coding (with a preference for program integrity coding) and ICD-10 and AMA coding guidelines with the ability to interpret complex medical documentation accurately.
Two (2) years of coding experience on multiple specialties.
Preferred:
Five (5) years coding and/or coding and billing experience.
Two (2) years’ experience assisting with SIU audits.
Managed Care experience.
Other facts
About McLaren Health Care
McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 28,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.
As part of its Graduate Medical Education (GME) program, McLaren maintains academic affiliations with medical schools at Wayne State University, Michigan State University and Central Medical University. McLaren’s seven (7) GME campuses offer 27 residencies and eight (8) fellowship programs that train over 650 future physicians annually. All GME programs at McLaren are overseen and managed centrally by the Department of Academic Affairs.
What you'll do
- The SIU Coder performs medical claims and records reviews to assist in investigations and ensures compliance with coding practices. They collaborate with SIU Auditors and serve as the subject matter expert for coding activities.
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