HCC Coder

UMass Memorial Health•Worcester, MA

11d•Onsite

About The Position

Interprets a wide variety of clinical and diagnostic documentation to determine the opportunity for Hierarchical Condition Category (HCC) diagnosis selection and/or removal in accordance with official coding guidelines. Assigns appropriate ICD-CM (current edition) codes to outpatient office-based claims, tracks capture results, and reports clinical documentation patterns and trends. Supports all risk adjustment projects by complying with CMS requirements.

Requirements

High School diploma or equivalent.
Medical coding training and medical terminology from an accredited program.
Must complete and pass certification program within one year from date of hire.
Certification(s) as a Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P), Certified Professional Coder (CPC), or Certified Risk Adjustment Coder (CRC).
Three (3) years of HCC and/or outpatient coding experience.
Thorough knowledge of risk adjustment payment mythologies
Thorough knowledge of ICD-CM (current edition) and CPT coding as well as CCI edits
Thorough knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.
Excellent interpersonal and communications skills and demonstrates professionalism
Excellent customer service skills with the ability to communicate efficiently.
Exceptional organizational skills with attention to detail.
Ability to work independently within established guidelines.
Ability to organize and coordinate multiple functions and tasks.
Ability to problem solve, organize and prioritize workload to meet productivity benchmarks.
Ability to withstand significant level of on-going pressure, and ability to deal with individuals with tact, discretion and diplomacy.

Nice To Haves

Recognized programs include: a. American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC).

Responsibilities

Upon review of the medical record, performs analysis on documentation to determine the appropriate ICD-CM (current edition) codes as defined by official coding guidelines and other recognized reference materials.
Builds partnerships and work within coding teams and other organization departments critical to HCC coding.
Reviews coded records for coding quality assurance.
Verifies documentation is present to substantiate codes assigned.
Participates in the continuous coding audit and performance management program.
Maintains coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies.
Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
Alerts management to any unusual or questionable situations, coding irregularities, or trends contrary to policies / procedures, so corrective measures may be taken.
Adheres to the coding and billing regulations established by the American Hospital Association (AHA), American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS).
Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation.
Complies with established departmental policies, procedures and objectives.
Attends variety of meetings, conferences, seminars as required or directed.
Demonstrates use of Quality Improvement in daily operations.
Complies with all health and safety regulations and requirements.
Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
Maintains, regular, reliable, and predictable attendance.
Performs other similar and related duties as required or directed.