02/11/2022
Certified Coder positions within our company are part of a dyad team of community-based clinicians and healthcare management professionals who support patients facing serious Illnesses. What makes your career greater with us? You can improve the health of others and help heal the health care system. You can work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
Job Summary: In this role, the certified coder manages the day-to-day responsibilities of chart abstraction and reporting in accordance with state and federal regulations. The coder will abstract inpatient and outpatient medical records and record findings to assist providers with accurate and detailed documentation. The coder ensures that all claims accurately reflect the appropriate diagnosis information based on documentation to the highest degree of specificity. The coder will respond to interdepartmental and provider inquiries guaranteeing that all work is in compliance with internal protocols and external compliance requirements
Primary Responsibilities:
Maintains an advanced knowledge and understanding of HCC/risk adjustment, coding and documentation requirements including a demonstrated ICD-10-CM proficiency
Demonstrates ability to perform accurate and complete chart reviews for HCC/Risk Adjustment
Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements
Review’s provider documentation and accurately assigns medical codes for diagnosis and procedures according to the appropriate classification system
Maintains knowledge of anatomy, physiology, and medical terminology to ensure that diagnoses and services are properly coded
Communicates with providers and clinical support staff to obtain missing information and documentation needed to code to the highest degree of specificity
Audits and reviews submitted medical records to identify diagnose/procedures, ensuring that Hierarchical Condition Categories (HCC) coding guidelines are followed
Provides physician education on RAF/HCC coding guidelines through monthly/quarterly audits and feedback
Ensures encounters are clean and ready for submission to payers for efficient and effective processing
Continues to stay current on insurance, billing and coding rationale, modifiers and authorizations requirements for accurate billing and coding
Handles highly sensitive and confidential information in compliance with Health Insurance Portability and Accountability Act (HIPAA), and company confidentiality policies and procedures
Comply with the standards of Ethical coding as set forth by the American Health Information Management Association and adhere to official coding rules
Maintains CEU’s to keep certifications current
Required Qualifications:
Active certified coder certification (CRC, CPC, CCS-P) through AHIMA or AAPC
Minimum 2 years’ experience as a certified coder, preferably in the primary care setting
Ability to code using an ICD-10-CM code book, encoder pro experience preferred
Strong clinical knowledge related to chronic illness diagnosis coding
Experience in effective data collection, organization, and evaluation systems for monitoring the quality of patient care.
Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Demonstrated ability to assist with focusing activities toward a strategic direction as well as to develop tactical plans, drive performance and achieve targets
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Dependable and reliable work ethic
Preferred Qualifications:
Experience coding in a risk adjustment model preferred
Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) and Medicare Advantage reimbursement
Coding in a Primary Care outpatient setting
3+ years’ experience in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements preferred
Our company is transforming the status quo of approaching end-of-life care – we want our patients to live their best lives now, and we advocate for our team members to do the same. We provide equitable opportunities to all employees and applicants regardless of race, religion, gender, s*x, age, physical ability, neurodiversity, and experiences; and we encourage all team members to come to work as their authentic selves. Supported and informed by our interdisciplinary team committed to inclusion and diversity, Prosperit
