Job Detail

The primary function of the Coding Specialist is to assist and educate QHP providers on proper coding of all current medical conditions to the highest specificity according to Medicare requirements for the Hierarchical Condition Category (HCC) risk adjusted payment model.

Minimum Experience

• Minimum two years of experience in HCC Coding for professional services required.

Required Licensure / Certification

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified Risk Adjustment Coding (CRC) from American Academy of Processional Coders (AAPC) or American Health Information Management Association (AHIMA) required.
• Must maintain current certification.

Job Duties & Responsibilities

• Complete electronic medical chart review for coding and documentation compliance.
• Provide detailed feedback to QHP providers about missed opportunities.
• Code chart based on assessment and plan.
• Identify training opportunities and provide feedback to lead clinician.
• Must be able to keep up with daily, weekly, monthly volume targets

Knowledge, Skills & Abilities

· Comprehensive understanding of the contents of a typical electronic medical record, medical terminology, abbreviations, ICD-9/ICD-10 coding conventions.

· Expertise in CMS Risk Adjustment Processing System (RAPS) for Medicare Advantage Plans, and medical coding, including but not limited to E/M, ICD-9 and ICD-10, CPT, and HCC coding.

· Must be confident in communication with physicians for discussion of diagnoses and risk adjustment coding.

· Proficient computer skills including Microsoft Office (Word, Outlook, Excel, PowerPoint).

· Uses independent judgment and initiative within established policies and procedures.

· Excellent communication skills, both written and verbal. Ability to change communication styles to meet the needs of the audience.

· Works effectively with others to encourage teamwork and productivity.

· Strong knowledge of healthcare and practice workflows, ideally in primary care.

· Knowledge of billing, claims, managed care.

· Knowledge of EHR systems.

· Must be able to take initiative and function independently.

· Ability to maintain confidentiality and PHI.

Job Type: Full-time

Pay: $50,000.00 - $65,000.00 per year

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• ICD-10: 1 year (Preferred)

License/Certification:

• Certified Professional Coder (Preferred)
• Certified Coding Specialist (Preferred)
• CRC (Preferred)

Work Location: One location