Responsibilities:
• Compile chart review findings statistics, analyze data results and implement meaningful action plans that improve providers’ performance levels
• Education new staff to produce and maintain high quality data abstraction and chart reviews
• Develop quality assurance processes to ensure data integrity of all submitted diagnoses to regulatory agencies and key stakeholders
• Evaluate and improve the effectiveness of risk adjustment coding programs, policies & procedures and work flow
• Work closely with inter-departmental team management to support coding initiatives related to risk adjustment programs
• As a Subject Matter Expert, this person will support risk adjustment coding initiatives to identify opportunities to enhance and grow business
• Responsible for educating and keeping management informed on current changes in regulations/guidance related to ICD-10 coding and quality documentation and reporting
• Interface with operations and clinical leadership to assist in identification of coding & documentation improvements and promote best practices
• Conduct mock audits or surveillance activities that target problematic diagnoses as identified by CMS and internal stakeholders
• Can understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.
• Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations.
• Maintains department productivity and accuracy standards.

• Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist , P from the American Health Information Management (AHIMA)
• Requires 5+ years of Medical Coding experience
• Requires a minimum of 5+ years’ experience in Health Insurance/quality chart audits and/or Utilization Review

• Bachelor's degree required

 

Knowledge

• Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding
• Requires knowledge of medical terminology of medical procedures, abbreviations and terms
• Requires knowledge of the health care delivery system

Skills and Abilities

• Requires the ability to utilize a personal computer and applicable software (e.g. proficiency in Word and Excel)
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team
• Must demonstrate professionaland ethical business practices, adherence to company standards and a commitment to personal and professional development
• Proven ability to exercise sound judgment and problem solving skillsProven ability to ask probing questions and obtain thorough and relevant information