Certified Professional Coder

Our patients have the peace of mind knowing that their health and well-being are our primary concerns.

We give our health plan clients the confidence that their members are well taken care of.

With over 11,000 at-risk members, we provide primary care and other services to seniors and families in our medical centers that are comfortable, convenient and staffed with caring professionals.

Our activity and wellness facilities are filled with health plan members who know us for our distinct events and programs that cater to the communities we serve.

Every day, we deliver on our promise to bring value based, quality healthcare to our patients.   Overview The Certified Outpatient  Medical Risk Adjustment Professional Coder  is responsible for reviewing encounter notes and other supporting documentation and assigning diagnosis codes and procedure codes to create claims.

Also, responsible for assigning appropriate level II codes to quality measures for HEDIS reporting.

Follows official coding guidelines and insurance regulations.

It is critical for the Certified Outpatient  Medical Risk Adjustment Professional Coder  to have knowledge of Medicare Risk Adjustment Methodology, HEDIS, CMS coding guidelines, and coding / documentation and billing standards and regulations.

THIS POSITION MAY REQUIRE TRAVEL TO OTHER LOCAL MEDICAL CENTERS.

Duties & Responsibilities Conducts workflows in Coding and Quality processes, medical record completion and department projects for accuracy in medical record documentation as needed.

Ensures proper code selection for compliance with ICD-10-CM Official Guidelines for Coding and Reporting.

Educates physicians on proper documentation and compliance.

Reviews medical record to include consultations (inpatient and outpatient) and hospital discharge summaries to ensure continuity of care and continued coding for accurate risk adjustment.

Performs pre-post audits to ensure medical record completeness, consistency, and compliance.

Works collaboratively with medical and supporting staff to follow-up on documentation needs to support the diagnosis and quality measures based on patient age and chronic conditions.

Uses only pre-approved source documents as validation for recommendations on documentation that meets the technical specifications in support of a measure.

Develops and maintains professional skills and knowledge through training programs including education sessions for ICD-10-CM and CPT codes.

Demonstrates a thorough understanding of Coding Guidelines.

Demonstrates understanding of company policies which impact Coding functions and takes ownership for compliance for own area of responsibility.

Collaborates with Supervisor as necessary to clarify and verify information.

Reports opportunities identified in concurrent and retrospective clinical documentation to support quality, regulatory compliance, and effective coding.

Participates in department meetings.

Consistently demonstrates awareness and willingness to fulfill Service Excellence Commitments.

Works collaboratively with team members, other departments, and clinical staff consistent with the Mission and Vision of the company.

Willingly performs similar or related tasks as assigned.

Assists in teaching any office staff and / or providers in proper documentation and coding guidelines as necessary.

Reports any issues to Quality, Compliance and Operations as necessary.

Accurately enters all identified and validated procedures codes in claims into the practice’s EMR.

Assists in all RAPS submission projects as they occur if needed.

Performs all other coding and documentation reviews and / or projects as asked and assists / coordinates strategies as defined by the department head or assistant.

Education & Experience :

• High school diploma or equivalent required.
• Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) through AAPC or AHIMA. 2 years of experience as Certified Professional Coder at minimum.
• Proficient in assigning ICD-10-CM codes according to provider documentation level to comply with federal regulations and insurance requirements.
• Computer skills, Word, Excel, HER.
• Medical background is a plus.

Required Skills / Abilities :

Physical Demands :

Benefits :