Coding and Billing Specialist

Community Care of North Carolina Inc•Garner, NC

3d•Onsite

About The Position

The Coding and Billing Specialist is responsible for providing expertise in the area of quality and risk adjustment coding. Interacts with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing billing rates, understanding clinical suspects, and monitoring of appropriate clinical documentation and quality coding. Ensures practices understand and are capturing yearly hierarchical condition categories (HCCs). Coordinate with the provider relations representatives and other key staff to support practices in the area of billing and coding, both at the individual practice level and at a larger systems-training level.

Requirements

Bachelor’s Degree highly preferred, OR Associate’s degree with two years of equivalent work experience, OR minimum of five years of equivalent work experience
REQUIRED: Active Certified Professional Coder certification. AAPC or AHIMA coding certification preferred.
REQUIRED Experience: Medical coding 3 years. Medical coding: 5 years (Preferred)
AAPC certified risk coder preferred
Experience in Risk Adjustment
Experience in HEDIS / Star Ratings
Experience training or mentoring providers & other healthcare professionals in billing and coding
Must possess a valid driver’s license
Knowledge of anatomy and physiology, medical terminology, pharmacological terminology, patient care documentation terminology
Experience working effectively with common office software, coding software, EMR and abstracting systems
Computer skills including fluency in MC Office applications
Proficient in ICD-10 CM, HCPCS and CPT coding
Knowledge in Hierarchical Condition Categories (HCCs)
Knowledge of Medicaid, Medicare, managed care, and commercial insurance.
Embrace our corporate culture, including our vision, mission, and values
Effective communicator who utilizes academic detailing (AD) skills; able to present oral and written information clearly, concisely and in a timely manner
Displays Emotional Intelligence (EI) skills through ability to respond versus react, accept, and utilize feedback, and maintain positive, respectful work relationships through self-management and strategic relationship building
Forward thinking and solution-oriented; able to turn challenges into opportunities and take actions to improve business processes
Able to manage multiple tasks/projects, including prioritizing duties, meeting deadlines, and providing on-time responses to management, supervisor, and co-worker requests
Demonstrate a commitment to detail, accuracy, and thoroughness
Punctual, reliable, able to begin work as scheduled and attend mandatory meetings
Analytical skills, sound judgment and self-direction are necessary as independent decisions and problem solving are required
Comfort with public speaking in front of people from multiple disciplines

Nice To Haves

Bachelor’s Degree highly preferred
AAPC or AHIMA coding certification preferred
Medical coding: 5 years (Preferred)
AAPC certified risk coder preferred

Responsibilities

Utilize extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Centers for Medicare and Medicaid Services (CMS) for accurate and optimized assignment and sequencing of diagnostic and procedural codes.
Able to provide guidance and training on appropriate modifiers according to guidelines. This includes and is not limited to deciding when the modifiers are appropriate to add onto CPT codes.
Be able to work directly with practices and internal provider relations and EHR specialists to educate and improve the accuracy, completeness, specificity and appropriateness of diagnosis codes, E&M coding based on services rendered and assign appropriate modifiers.
Able to identify existing or potential problems, gather relevant information, and analyze the information to identify probable causes of problems. Applies knowledge, experience, and common sense and considers alternatives when deciding on the best potential solutions.
Plan, implement, and facilitate presentations and training to large and small internal and external groups on HCC Risk Adjustment and Star rating concepts and critical success factors based on trends and areas of opportunity.
Monitor and analyze key program and population metrics such as risk recaptures rates and risk adjustment factor at the organization level and the practice level.
Participate in quality improvement efforts serving as a coding and risk adjustment coding resource for network providers, as well as other internal and external partners.
Responsible for actively identifying opportunities of improvement and developing and driving annual training initiatives, for both internal and external audiences, related to coding, STAR metrics and risk adjustment coding management for the populations served.
Assist providers and coding/billing staff in understanding the Medicare Stars quality and CMS - HCC Risk Adjustment driven payment methodology, CPT Category II codes and the importance of proper chart documentation of procedures and diagnosis coding.
Assist practices with implementing CPT Category II codes to facilitate quality measures performance.
Provides measurable, actionable solutions to providers and internal teams that will result in improved accuracy for documentation and coding practices.
Collaborates with providers, coders, practice staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts.
Be a player-coach, serving as a coding expert for your team as well as external and senior stakeholders.
Interpret, apply, and explain applicable rules and regulations.
Abide by the American Health Information Management Association (AHIMA) Standards of Ethical Coding and adhere to official coding guidelines.
Research coding requirements for new and existing contracts.
Coordinating with teams across the organization to relay information.
Maintains strictest confidentiality and follows HIPAA compliance.
Other job duties as required.