Experience :- 1 Year
Vacancy :- 1
Location :- USA
Salary :- 80K
Job Type :- FTE
Activity / Project Role: American Academy of Professional Coders (AAPC) Certified Professional Coder (CPC)
The Consultant is responsible for translating the health plan’s current DOFR into a set of current industry standard codes. The consultant will translate the most current Industry Collaboration Effort (ICE) Division of Financial Responsibility (DOFR) a document that explains which expenses get paid by which organization in an agreement between VHP and another Health Plan,Hospital, and Medical Group utilized by the health plan and update it with changes to codes that have become effective or terminated since the creation of the DOFR.
Additional responsibilities will include the creation of documentation as it pertains to business requirements, configuration and training.
• translate VHP’s current DOFR into a set of current industry standard codes.
• take the most current ICE DOFR utilized by VHP (entitled “VHP DOFR 2019 V1” (DOFR)) and update it with changes to codes that have become effective or terminated since the creation of the DOFR.
• incorporate code changes from 8.20.19 to the present.
• Create the contract Exhibit in a Word format that looks comparable to what I have attached entitled “Valley Health Plan Full Professional Capitation DOFR”.
• requires modification to reflect the codes associated with each specific Service Category.
• Create configuration documents as specified by the Configuration Manager (Brandon Wilson).
Training and Experience: Sufficient education, training, and experience to demonstrate the possession and direct application of the following knowledge and abilities.
• AAPC Certified Professional Coder (CPC) – required
• Certified Outpatient Coder (COC) - optional
• QNXT Core Claims System
• QNXT DOFR Module functionality
• Coding guidelines and medical terminology to utilize and assign appropriate coding
• Applicable versions of ICD, CPT-4 and HCPCS coding systems
• Principles and practice of accurate and compliant abstracting and coding techniques
• Managed care operation concepts and principles
• Professional and institutional claims
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