Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care.
Performs ongoing member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles to minimize risk and denials.
Demonstrates understanding of current provider office billing practices, ensuring that diagnosis and CPT codes are submitted accurately.
Documents results/findings from chart reviews and provides feedback to leadership, providers, and office staff.
Provides training and education to the provider network regarding risk adjustment and coding updates related to risk adjustment.
Builds positive relationships between providers and the business by providing coding assistance as needed.
Facilitates administrative duties such as planning, chart review scheduling, medical records procurement, provider training, and education.
Assists in coordination of management activities with other departments including finance, revenue analytics, claims, encounters, and enterprise/plan medical directors.
Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies related to medical coding in the managed care industry.
At least 2 years medical coding experience, or an equivalent combination of relevant education and experience.
Certified Professional Coder (CPC).
Certified Coding Specialist (CCS).
Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge.
Ability to maintain confidentiality and comply with HIPAA.
Ability to effectively interface with staff, clinicians, and management.
Excellent verbal and written communication skills.
Ability to establish and maintain positive and effective work relationships with coworkers, members, providers, and all other customers.
Strong proficiency in Microsoft Office suite and applicable software.
Preferred qualifications include Certified Risk Adjustment Coder (CRC), Certified Professional Payer (CPC-P), Certified Coding Specialist – Physician Based (CCS-P), familiarity with HCC Risk Adjustment Model, background in supporting risk adjustment management and clinical informatics, and experience with risk adjustment data validation.
Location
N/A
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago