This position is accountable for accurately reviewing, interpreting, auditing, coding, and analyzing medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction.
Review may include inpatient, outpatient treatment, and/or professional medical services according to ICD-9/ICD-10-CM coding guidelines and risk adjustment model regulations.
This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual risk adjustment life cycle for Medicare, Medicaid, and Commercial lines of business.
Responsibilities
- Understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.
- Review medical records for completeness, accuracy, and compliance with applicable coding guidelines and regulations.
- Identify, compile, and code member/patient data using ICD-9/ICD-10-CM and other standard classification coding systems.
- Support the collection and distribution of documentation and coding improvement tools for designated practice units as applicable.
- Support educational activities for internal stakeholders as necessary as a subject matter expert on coding review and guidelines.
- Actively participate and engage in program improvement discussions and activities.
- Maintain department productivity and accuracy standards.
Required
- Current Registered Health Information Technologies (RHIT), Certified Professional Coder (AAPC), or Certified Coding Specialist, P (AHIMA) credential.
- 2+ years of medical coding experience.
- Minimum 2 years of experience in health insurance quality chart audits and/or utilization review.
- Bachelor's degree preferred.
Preferred Skills
- Proficiency in CPT-4, HCPC, and ICD-9/ICD-10 coding.
- Knowledge of medical terminology, procedures, abbreviations, and terms.
- Knowledge of the healthcare delivery system.
- Ability to use a personal computer and applicable software such as Word and Excel.
- Effective verbal and written communication skills and the ability to work well within a team.
- Professional and ethical business practices, adherence to company standards, and commitment to personal and professional development.
- Strong sound judgment and problem-solving skills.
- Ability to ask probing questions and obtain thorough, relevant information.
Location
Newark, New Jersey, US
Employment Type
Not specified
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago