Reviews medical documentation from physicians and other healthcare providers and assigns diagnostic and procedure codes for symptoms, diseases, injuries, surgeries, and treatments according to official classification systems and standards.
The role works with other departments and organizations to help ensure the availability and quality of information and to identify healthcare trends, issues, and concerns.
Requirements & Qualifications
Skills and qualifications
- 3+ years of clinical and Medicare Risk Adjustment experience
- Knowledge of clinical standards of care, preventive health standards, and Medicare risk coding
- Ability to evaluate medical records with strong attention to detail
- Strong organizational skills and ability to work independently and as part of a team
- Ability to interact with medical staff, peers, and internal company staff at all levels
- Ability to use databases and prepare reports as needed
- ICD-10 proficiency from an accredited organization required
- Experience abstracting and coding medical record information in the professional provider setting for billing government or commercial insurance carriers, or in support of Risk Adjustment/HCC diagnoses
- Ability to stay current on coding guideline changes and updates
- Proven coding skills with the ability to interpret and apply federal and state regulations, coding and billing requirements
- Ability to provide feedback constructively and with sensitivity
- Ability to identify coding trends and risk areas
- Knowledge of CMS reimbursement methodologies and Hierarchical Condition Category risk adjustment disease model categories
- Excellent written and verbal communication skills
- Ability to maintain confidentiality of provider, patient, and patient account data
- Strong critical thinking skills with the ability to resolve complex coding issues and perform root cause analysis
- Experience with data entry into a database and/or software tools
- Proficiency with Microsoft Word and Excel
Benefits & Perks
Benefits
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Location
California, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
Yes
Posted
8 months ago