Manages claims coding rule process. Evaluates claims coding rule change request from clinical, financial, and claims operations perspectives. Provides regulatory and correct coding research on change requests and makes recommendations on correct payment policy and edit functionality. Defines requirements and partners with vendors throughout testing and implementation. Supports provider dispute/appeal team.

+ Manages research of claims coding rule initiatives including the development of detail work plans.

+ Receives and logs requests of changes for tracking purposes.

+ Maintains a library of all the existing and retired rules, the source of the rule and the implementation/retire date of the rule (by Group/Plan/Division).

+ Documents supporting authority for each claim coding rules by Group/Plan/Division (Master Grid).

+ Participates in cross-functional teams to address key claims coding rule issues facing the organization.

+ Adminis...