Coding Quality Specialist
HealthSpring 39 reviews - Nashville, TN

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Responsible for reviewing and auditing coded records across markets for coding quality. Responsible for reporting findings, making recommendations, and creating action plans.

Required Skills

Responsible for conducting reviews/audits on coded records to ensure that the assigned ICD code(s) follow guidelines and are supported by the clinical documentation. Responsible for reporting findings for proper distribution and education. Ensures policies and procedures are monitored and updated to include regulatory changes. Responsible for reporting findings, making recommendations and creating action plans for distribution to the appropriate coding teams. Ensures compliance with recommendations. Responsible for reporting trends and suggesting processes to monitor and/or improve areas of need discovered during review/audit.

Required Experience

Minimum Requirements: Bachelor’s Degree. At least three years of coding experience. Certified Professional Medical Auditor (CPMA). Certification as a Certified Professional Coder (CPC), Certified Coding Specialist – Physician (CCS-P), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), and/or Registered Health Information Administrator (RHIA). Extensive knowledge of ICD-9-CM/ICD-10-CM, CPT, and CMS coding principles and guidelines. Prior audit / quality experience. At least two years managed care experience. Familiarity with physician-specific regulations and polices related to documentation and coding. Knowledgeable of Medicare Risk Adjustment. Proficiency with ICD-9-CM/ ICD-10-CM coding. Must be detail oriented, self motivated, and have excellent organization skills. Proficient in Microsoft Office products, specifically Excel. May require up to 50% regional travel.

Preferred Requirements:
HealthSpring is an EEO/AA employer.

About this company
39 reviews
Looking to keep a spring in Grandma's step, HealthSpring provides Medicare Advantage plans and Medicare Part D prescription drug...