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Position SummaryResponsible for performing quality inter-rater review audits of medical records coded by internal team (CDQA and Sr CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
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The Key Responsibilities: ·Performs medical record validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
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AAPC or AHIMA certification in coding within one year of hire with experience in research medical billing and coding. Screen research protocols to determine whether a formal Medicare Coverage Analysis (MCA) is required.
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Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
$18.5 - $35.29 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Expertise in CMS Risk Adjustment Data Validation (RADV) for Medicare Advantage Plans, and medical coding, including but not limited to E/M, ICD-10, CPT, and HCC coding preferred. An equivalent combination of Risk Adjustment Coding work experience and other relevant American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification may be substituted for the stated certification requirements.
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ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services.
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Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) as a CPC, CCS-P, CEMC or CPMA. Must remain current on coding/reimbursement requirements of Medicaid, Medicare and other third party payers.
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Prefer certification as any of the following - American Academy of Professional Coder (AAPC) Certified Professional Coder (CPC) or American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS.
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Who Should Apply: If you have experience as a certified coder, medical coder, Medicare risk adjustment, CPC, CRC, medical coding specialist, remote coder, medical coding, MRA, HCC, hierarchal condition categories, or risk adjustment, we would love for you to apply.
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Specialized Credentialing through AAPC. Assigns procedures, E&M, and diagnoses codes as documented in the medical records all within the professional coding guidelines, Centers for Medicare and Medicaid (CMS) guidelines, and policies to obtain reimbursement.
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Certifications: Certified Professional Coder (CPC) certification through AAPC or Certified Coding Specialist-Physician based (CCS-P) certification through AHIMA. A working knowledge of Medicare, Medicaid, Blue Cross, CHAMPUS and other third party payers.
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Must be familiar with Medicare and Medicaid billing policies & procedures. Abides by the Standards of Ethical Coding as set for by AHIMA and AAPC. One of the following required: Certified Coding Specialist - Physician based (CCS-P), Certified Procedural Coder (CPC), Registered Health Information Administrator (RHIA), or Registered Health Information Technologist (RHIT.
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The following certifications are acceptable-RHIT/RHIA/AAPC, CPC, or CPMA. Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and other Third Party Payor rules and Regulations.
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License(s): None Certification(s): AAPC, AHIMA or Certified Coding credential (excludes apprenticeship classification) required. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10- CM diagnostic codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.
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Remains up-to-date on billing protocols, pricing methodologies, proper utilization of global edits, Medicare LCDs, and the CCI. Remains current with federal legislative changes that effect coding and reimbursement.
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