Codes hospital records for the purpose of reimbursement, research, and compliance with federal regulations according to diagnosis, operation, and procedure on a concurrent basis. May act as a custodian of records responsible for insuring the proper release of medical information needed for legal actions (subpoenas)..
Under the direction of the Quality Assurance Manager, performs accurate and timely review and validation of Medicare Advantage HCCs through medical record reviews. The Coder audits provider documentation of ICD-9-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment guidelines. The Coder will lead efforts to evaluate the HCC coding practices and provide analyses and recommendations to improve overall provider documentation and coding. The Risk Adjustment Coder will review medical records to determine if diagnostic codes (ICD-9-CM) are accurately reflecting the provider documentation. The coder will summarize findings for internal and external parties.
Business Degree preferred. Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC-H) certification or CCS (Certified Coding Specialist)
5 or more years of coding experience is preferred. Three or more years of coding experience in health plan, hospital or physician practice billing and/or hospital care management environment required. Prior experience with Risk Adjustment coding and auditing preferred.
Thorough knowledge of ICD-9-CM and the documentation needed to support them. Ability to write clearly and succinctly in a variety of communication settings and styles. Ability to interact with providers and other office staff through presentations and other face to face meetings. Ability to train providers on documentation required to support ICD9 and HCC codes a plus.
Thorough knowledge of medical terminology and ICD-9-CM documentation. Understanding of both the medical and business side of healthcare operations. Ability to read and understand Medicare guidelines. Professional, highly organized, self-motivated, detail-oriented and energetic team player who can also work independently. Ability to multi-task in a fast-paced environment. Must be detail oriented. Strong computer skills including MS Office particularly Excel and Word, Internet, and E-mail, the ability to navigate internal network and external internet data portals required, Microsoft Access and Excel Intermediate to Advanced level skills preferred. Strong organization skills and an ability to work autonomously required Enjoys working in a team environment and participating in the development of departmental quality initiatives.
Excellent problem solving ability and strong interpersonal skills and the ability to write clearly and succinctly in a variety of communication settings and styles. Ability to effectively communicate with multi-level personnel, medical professionals, clients, public and other representatives of the business. Excellent verbal and written communication skills. Self starter with ability to learn quickly. Ability to successfully work on multiple projects/accounts simultaneously with frequent interruptions
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: Commitment to maintain complete confidentiality of patient health information. Reliable transportation, car insurance and a valid driver's license
Location: Greater Houston area