HCC Coder - Remote AZ
About The Position
The Coder Specialist reviews medical records retrospectively and abstracts the highest-specificity diagnosis codes supported by the documentation. The coded data is submitted to CMS to determine accurate risk adjustment factors used in adjusting payments for members’ future healthcare costs. Diagnosis codes must be selected from face-to-face visits with valid risk-adjustable providers and assigned according to the medical record and the applicable ICD-9 or ICD-10 rules based on the date of service. This Arizona-based remote opportunity is expected to be 70% remote. The employee must be able to travel to the office for meetings or education when required, and to network providers to provide coding education. The role requires a full-time schedule of at least 40 hours per week, plus additional hours as requested or needed to meet business requirements.
Requirements
- At least 3 years of coding experience.
- High school diploma or GED.
- Current certification as CPC, CPC-I, COC, CRC, CCS, CCS-P, CPMA, or RHIT.
- Comprehensive understanding of coding guidelines, rules, regulations, and methodology.
- Knowledge of anatomy and physiology, major disease processes, and pharmacology.
- Understanding of etiology, pathology, signs and symptoms, diagnostic studies, and treatment modalities.
- Knowledge of CMS and commercial health plans.
- Strong customer service skills and techniques.
- Strong knowledge of HEDIS measures and their requirements.
- Strong knowledge of risk adjustment and HCC coding.
- Strong oral and written communication skills.
- Ability to interact effectively with staff, customers, and management at all levels.
- Flexibility and willingness to embrace change.
- Ability to understand typical medical charts, medical terminology and abbreviations, ICD-9/ICD-10 conventions and guidelines, what adequately substantiates a diagnosis, and which providers, documents, and facilities are appropriate for code capture.
- Ability to work at least 40 hours per week, with additional hours as requested or needed to meet business requirements.
Nice To Haves
- Three years of coding experience with clinical and HCC experience.
- Clinical training as a Medical Assistant, Registered Nurse, Licensed Practical Nurse, or Certified Nursing Assistant.
Responsibilities
- Review medical records and accurately and efficiently abstract diagnosis data.
- Apply coding guidelines, rules, regulations, and methodology, using ICD-9 or ICD-10 as applicable to the date of service.
- Ensure selected diagnosis codes are supported by documentation from a face-to-face visit with a valid risk-adjustable provider.
- Maintain coding quality and accuracy at the industry standard of 95% or better in quality-assurance audits.
- Communicate documentation inefficiencies to the Clinical Correlations team.
- Communicate professionally with care provider offices, clinics, hospitals, other clinical facilities, and Medicaid Business Segment staff.
- Maintain coding certification and stay current with industry changes.
- Comply with HIPAA and patient confidentiality requirements.
- Analyze data and report known claims-data inaccuracies to management.
- Provide feedback to Clinical Correlations and the Manager regarding identified education needs.
- Travel to the office for meetings or education when required, and to network providers to provide trending coding education.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
