HCC Coder - Remote AZ
About The Position
The Coder Specialist reviews medical records retrospectively and abstracts the most specific diagnosis codes supported by the documentation. The coded data is sent to CMS to help determine risk adjustment factors used to adjust payments for members’ future healthcare costs. Codes must be assigned and sequenced according to the medical-record documentation and the applicable ICD-9 or ICD-10 coding rules based on the date of service. The coder must ensure selected diagnoses come from a face-to-face visit with a valid risk-adjustable provider. This is a full-time remote opportunity for Arizona residents, with work performed within Arizona. The position is expected to be 70% remote and requires the ability to travel to the office for meetings or education, or to network providers to provide trending coding education. The role requires maintaining coding certification and meeting an industry-standard accuracy rate of 95% or better in quality audits.
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.
- Knowledge of anatomy, physiology, major disease processes, and pharmacology.
- Knowledge 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 meet the full-time schedule of at least 40 hours per week, plus additional hours as requested or needed to meet business requirements.
- Arizona residency and work performed within Arizona.
- Ability to travel to the office or network providers when required.
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
- Conduct medical record reviews and accurately and efficiently abstract data and diagnosis codes.
- Apply coding guidelines, rules, regulations, and methodology, including ICD-9 or ICD-10 conventions based on the date of service.
- Confirm selected diagnoses are supported by documentation from a face-to-face visit with a valid risk-adjustable provider.
- Communicate documentation inefficiencies to the Clinical Correlations team.
- Maintain coding quality and accuracy at 95% or better in quality assurance audits.
- Communicate professionally and effectively with 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 about identified education needs.
- Travel to the office for meetings or education, or to network providers to provide trending coding education, when required.
- 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
