Job Description

Responsibilities:

Understand and represent PRI's mission, vision, and values to all internal and external customers

Audits chart notes and external documentation based on industry standard coding guidelines

Review charts, code chronic disease that meets HCC and Risk Adjustment criteria

Utilizes technical coding principals and APC reimbursement expertise to assign appropriate diagnoses and/or procedures

Ensures optimal reimbursement of all cases in compliance with CMS policies and procedures and Official Coding Guidelines

Keeps abreast of coding guidelines and reimbursement reporting requirements

Ensures production and quality expectations are met

Communicates professionally and effectively with physicians and staff

Performs accurate chart reviews and assigns appropriate ICD-10 CM codes based on documentation in chart

Identifies and reports issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding guidelines

Maintains consist daily production of greater than 30-50 reviews per day.

Maintains 98% accuracy rate

Demonstrates the ability to appropriately use coding principles to code to the highest specificity and complies with CMS regulations and company goals and policies

Reports operational concerns to manager for Quality Improvement of daily processes

Demonstrates knowledge of various document types - e.g. paper records and electronic records

Performs other duties and responsibilities as required

POSITION REQUIREMENTS

Associate Degree required

Management/leadership experience

Must be an HCC Certified Coder with CCS or CPC

Minimum of five years HCC Coding Risk Adjustment experience required

Knowledge of current issues, trends, and changes in the laws and regulations governing

medical ICD-10 CM coding and documentation

Understand and adhere to The Health Insurance Portability and Accountability Act (HIPPA) requirements

Maintains professional certification with continuing education credits

Knowledge of Microsoft office suite such as Outlook, Access, Excel, Word and MS Project with emphasis on MS Excel capabilities

Excellent organization and time management skills along with excellent oral and written communication skills

Ability to learn quickly, build and maintain long term relationships and work with minimal supervision

Ability to work well with others with diverse backgrounds and at various organizational levels

Ability to work well within a team

Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)

Ability to obtain and maintain U.S. Government Security Clearance

Preference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area. (Go to http://map.sba.gov/hubzone/maps/ for more information).

DEGREE

CERTIFICATION

SPECIALTY/SUBSPECIALTY

POSITION HCC Certified Coder II

LOCATION Provider Resources Inc - Nationwide

EOE STATEMENT PRI is an equal employment opportunity employer. All qualified applicants including Disability/Vets or other qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

Responsibilities

Review medical charts and documentation to extract relevant information

Assign appropriate diagnosis codes according to industry standards and coding guidelines

Ensure accuracy and completeness of coded medical records

Adhere to compliance regulations and guidelines in coding practices

Collaborate with healthcare providers to clarify documentation or resolve coding-related issues

Stay up-to-date with changes in coding guidelines and regulations

Qualifications

Certification in medical coding, such as Certified Professional Coder (CPC)

Strong knowledge of medical terminology, anatomy, and physiology

Familiarity with ICD-10-CM coding guidelines and CMS-HCC coding methodology

Experience in coding for risk adjustment or HCC coding

Attention to detail and ability to work with complex medical records

Excellent analytical and problem-solving skills

Effective communication and interpersonal skills

Skills

Certified Professional Coder (CPC)

Medical terminology

Anatomy and physiology

ICD-10-CM coding

CMS-HCC coding methodology

Risk adjustment coding

Attention to detail

Analytical skills

Problem-solving skills

Communication skills

Job Types: Full-time, Permanent

Pay: ?20,000.00 - ?40,000.00 per month

Schedule:

• Day shift

Experience:

• total work: 2 years (Required)

Work Location: In person