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Manager Coding Quality Risk
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- Demonstrates experience by correlating coding accuracy with correct HCC assignment for MA/Risk and/or CPT, ICD-10, HCPCS and Modifiers for FFS. Complies with all aspects of Coding and Corporate Compliance standards.
- Demonstrate understanding of relevant systems and coding software applications (e.g. Practice Management Systems, EMRs, MS Office, Medical Coding software) Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes.
- Follow up with providers as necessary when responses to queries are not provided in a timely basisRead and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions)Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current HCC and/or CPT-4, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials.
- AAPC or AHIMA approved coding certification program.
- CPC, CRC or RHIT certification EXPERIENCE:Minimum:Must have 3-5 years of coding experience in a Primary Care/Specialty environment.
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