Position Summary
The HCC Coder is responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with accepted and established standards. This role collaborates with the Billing Manager and Medical Director to support the correct use of coding classifications, including ICD-10-CM, CPT, E&M, and record documentation, to ensure compliance in the collection of outpatient diagnoses and services.
Schedule
- Full-time, non-exempt
- Flexible schedule; may require some evenings and weekends
Primary Responsibilities
- Review medical records to ensure accurate coding, documentation, and claim completeness.
- Communicate with providers when documentation is inadequate, ambiguous, or unclear for coding purposes.
- Create training presentations to educate staff on Medicare coding guidelines, with emphasis on HEDIS and Risk Adjustment HCC quality measures.
- Lead the development and implementation of special projects, including new processes, policies, and procedures related to coding requirements.
- Attend weekly meetings and present HCC Risk Adjustment Coding Department feedback, including data analysis and summary details.
- Provide workflows and worksheets as needed.
- Attend coding- and billing-related trainings and webinars and provide debriefings to management and providers.
- Perform other duties as assigned.
Requirements & Qualifications
Minimum Qualifications
- Computer and software proficiency, including EHR and Microsoft Office (Word, Excel, Outlook, PowerPoint)
- Excellent communication skills
- Knowledge of payer billing rules and guidelines, including Medi-Cal and Medicare
- Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines
- Knowledge of CMS HCC Risk Adjustment coding and data validation requirements preferred
- Ability to work both independently and as part of a team
- Reliable transportation
- Ability to travel between facilities, including approximately 10% travel outside the local area
- Compliance with federal and state privacy laws and regulations, including HIPAA and HITECH
Education and Experience
- Bachelor's degree in healthcare preferred
- Coding certificate from an accredited institution preferred (CCS, CPC)
- 2+ years of experience in healthcare as a coder
- Technical expertise in ICD-10, CPT, HCPCS, and HCC coding
- Valid state identification
- Commitment to the goals and philosophy of Northeast Community Clinic
Location
California, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago