HCC Coding Specialist - Exempt - Full Time - Days - 8hr Covina

Emanate Health • Covina, CA

83d • $33 - $48

About The Position

Emanate Health is seeking a Coding Specialist responsible for the oversight of HCC Program and STAR measures coding related functions. The coding specialist will collaborate with the IPA Director, Health Plan, and MSO personnel on HCC and STAR measures related tasks. This role is crucial in ensuring that the IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon a 4.0 STAR rating. The coding specialist will provide education to external physician offices and work closely with physicians and billers to ensure the appropriate ICD-10 and CPT codes are submitted for Medicare and Covered CA lines of business. Responsibilities also include reviewing medical records and claims data to ensure external physicians are documenting correctly and submitting the correct ICD-10/CPT codes. The coding specialist will be responsible for summarizing and presenting information in a professional and effective manner, assigning diagnostic/procedural codes to inpatient and outpatient medical records, ensuring that all accounts are coded accurately and timely, following up on un-coded accounts, and researching and helping resolve problem accounts.

Requirements

• Associate degree preferred; college degree preferred with coursework in Medical Terminology, Anatomy & Physiology, and Computer experience.
• At least one year of experience in Medicare HCC program within IPA, HMO, or clinic setting.
• Two to five years of coding experience using ICD-9, ICD-10, and CPT coding systems.
• Excellent customer service skills required.
• Licenses: CMC, CCS, CPC, or COC required.

Responsibilities

• Oversee HCC Program and STAR measures coding functions.
• Collaborate with IPA Director, Health Plan, and MSO personnel on related tasks.
• Ensure IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon a 4.0 STAR rating.
• Educate external physician offices on coding requirements.
• Work closely with physicians and billers to ensure correct ICD-10 and CPT codes are submitted.
• Review medical records and claims data for accurate documentation and coding.
• Summarize and present information professionally and effectively.
• Assign diagnostic/procedural codes to inpatient and outpatient medical records.
• Ensure timely and accurate coding of all accounts.
• Follow up on un-coded accounts and resolve problem accounts.

Benefits

• Competitive pay range of $33.00 - $48.87 per hour.
• Supportive work environment that treats employees like family.
• Opportunities for professional development and growth.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees