RN Field Coder

UHS•McAllen, TX

12d•Hybrid

About The Position

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Job Summary: The RN Field Coder will be responsible for documentation and coding review of medical records where services are rendered at various partnered medical practices. The RN Field Coder will work with assigned provider offices to ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work supported by the RN Field coder will include pre, post and wraparound visit input. Pre-Visit: Reviewing the medical records, outside results and health plan data for upcoming patient appointments and flagging important insights for the provider to review before seeing the patient. Post Visit: review the provider note, populate all supported codes (ICD-10, CPT, CPT-II, etc.), and assist submission of encounter for claim processing. Wrap Around Education- periodic review of findings, highlighting areas of opportunity in documentation and ongoing education. The Field Coder will be responsible for provider querying and education on documentation guidelines. This individual must have a strong understanding and knowledge of CMS Coding and Documentation Guidelines as well as HCC coding practices. The RN Field Coder will be required to work occasionally onsite at the provider office and may require travel to out of state for in person provider education and training. The RN Field Coder will be required to maintain consistent and reliable methods of communication to accommodate the hours and demands of providers’ schedules

Requirements

Active RN License – Texas
Associates degree acceptable.
Minimum of two (2+) years in CMS HCC Risk Adjustment Coding.
Minimum of two (2+) years’ experience in medical records, claims or billing area is an asset or equivalent combination of education and experience.
Coding certification required (CPC, CRC) Must be credentialed through AAPC or AHIMA.
Experience working in a variety of EMRs
Knowledge of age-specific needs and elements of disease processes and related procedures required.
Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes.
Proficient with MS Office Suite (Word, Excel, Outlook), Internet.
Ability to read and write effectively in English
Highly organized, proficient critical-thinking and analytical problem-solving skills
Ability to work independently in a time oriented environment is essential.

Nice To Haves

BSN- preferred but not required.
bi-lingual Spanish preferred
Working knowledge of inpatient admission criteria, Medicare reimbursement system and coding systems preferred, but not required.

Responsibilities

Reviewing the medical records, outside results and health plan data for upcoming patient appointments and flagging important insights for the provider to review before seeing the patient.
Review the provider note, populate all supported codes (ICD-10, CPT, CPT-II, etc.), and assist submission of encounter for claim processing.
Periodic review of findings, highlighting areas of opportunity in documentation and ongoing education.
Provider querying and education on documentation guidelines.
Maintain consistent and reliable methods of communication to accommodate the hours and demands of providers’ schedules.