Spec, Coding

CVS Health•Work At Home-Texas, TX

18h•Remote

About The Position

The Coding Specialist is responsible for verifying and ensuring the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on the documentation and services rendered. The Coding Specialist will be expected to adhere to ICD-10-CM Official Guidelines and any internal guidelines that support accurate and complete capture of the patient’s holistic health picture.

Requirements

Must hold an active CPC, COC, CCS, CCS-P or CCA
Current coding certification in good standing
Minimum of 1 year of ICD-10 coding experience
Prior work experience in the healthcare field specifically related to coding is preferred
Experience and knowledge of Medicare, ACA Exchange or Medicaid HCC coding preferred
Experience with medical record documentation
Prior medical chart auditing/quality experience preferred
Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology

Nice To Haves

CRC preferred

Responsibilities

Review health risk assessments/evaluations to accurately and completely assign all ICD-10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis
Identify opportunities to query providers as necessary for clarification of documentation or conflict resolution to enable the proper application of ICD-10 HCC diagnosis codes
Communicate timely and effectively with the supervisor regarding issues with the health risk assessments/evaluations and/or corrections required to the health risk assessments/evaluations
Understanding the relationship between ICD-10 coding and HCC (hierarchical condition category) coding
Maintain adequate knowledge of coding, compliance, and reimbursement procedures related to Medicare Risk Adjustment
Make recommendations for coding policy/changes
Maintain coding certification after achieving certification status
Complete special projects as assigned by management, which require defining problems, and implementing required changes
Responsible for the security and privacy of all protected health information that may be accessed during normal work activities