Clinical Quality Coder II

Sutter Health • Washington, DC

1d • $34 - $51

About The Position

This position conducts review of outpatient medical records using International Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage, ICD-10-CM, and Centers for Medicare and Medicaid Services (CMS) coding and reporting guidelines. Performs medical record reviews to ensure accurate assignment of medical diagnoses and procedures. Responsible for pre-appointment review of each encounter in scope, including Medicare Advantage encounters, to ensure accurate reporting of diagnoses and to alert the physician of potential clinical conditions that may require review.

Requirements

• HS Diploma or General Education Diploma (GED)
• CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or AAPC Coding Certification (CCS-P, CPC, COC or CPC-P)
• 1 year recent relevant experience.
• Advanced knowledge of ICD-10 diagnosis coding conventions and requirements, knowledge of Quality Coding Program requirements such as the Medicare Advantage Coding Program/HCC, as well as medical terminology and abbreviations of disease, illness and injury process.
• Proficient use of grouper software and/or coding reference books to assign/validate diagnosis codes.
• National Correct Coding Initiative edits, Coding Clinic and CPT Assignment coding guidelines and the contents of a medical record.
• Ability to work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions.
• Demonstrated written and verbal communications skills to explain sensitive information clearly and professionally.

Responsibilities

• review of outpatient medical records using International Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage, ICD-10-CM, and Centers for Medicare and Medicaid Services (CMS) coding and reporting guidelines.
• medical record reviews to ensure accurate assignment of medical diagnoses and procedures.
• pre-appointment review of each encounter in scope, including Medicare Advantage encounters, to ensure accurate reporting of diagnoses and to alert the physician of potential clinical conditions that may require review.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED