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As an Accounts Receivable Representative – Medical Coder, you will be responsible for a variety of advanced revenue related billing and coding activities requiring data research and analysis, time management, self-motivation, and teamwork.
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This job will deliver value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and/or Affordable Care Act (ACA) using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, and Centers for Medicare and Medicaid Services (CMS) coding guidelines.
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The Professional Coding Auditor Educator performs medical record audits including but not limited to analysis of medical record documentation, validation of primary and secondary diagnoses and procedures; and ensuring proper assignment of diagnosis and procedure codes using coding guidelines established by the Centers for Medicare and Medicaid Services (CMS.
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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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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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The Coding Quality Specialist will apply guidance provided for the medical record code abstraction primarily for Medicaid lines of business (Complete Code Capture), but may also include Medicare Advantage Risk Adjustment or Commercial Risk Adjustment.
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Requires at least one of these certifications: RHIA, RHIT, CCS, CCS-P, CCS-H, CPC, or CPMA. Required to have CRC certification (Certified Risk Adjustment Coder) or obtain within 1 year of hire.
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ABOUT SHERIDAN MEMORIAL HOSPITAL At Sheridan Memorial Hospital, we are proud to have achieved the 5-Star Quality Rating, ranking us in the top 13.6% of hospitals rated by the Centers for Medicare and Medicaid Services.
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AHIMA certification as Registered Health Information Technician (RHIT) or AAPC Certification as a Certified Professional Coder (CPC), Certified Professional Biller (CPB) or Certified Professional Medical Auditor (CPMA), Certified Outpatient Coder (COC), or Certified Professional Compliance Officer and/or CHC Certification in Healthcare Compliance (CHC) or as a Certified Compliance and Ethics Professional or equivalent professional certification preferred.
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Certified Professional Coder Apprentice (CPC-A) OR Certified Professional Coder (CPC) OR Certified Risk Coder Apprentice (CRC-A) OR Certified Risk Coder (CRC) OR Certified Coding Specialist (CCS) OR Registered Health Information Technician (RHIT.
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Partners with leadership to improve HCC and other Risk Adjustment capture with provider and coder education. Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), CRC or Certified Documentation Expert Outpatient (CDEO) accreditation is required.
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Certified Risk Adjustment Coder (CRC) 5+ years of risk adjustment coding experience, 3+ national Medicare Advantage health plan experience preferred. This role is responsible for supporting Cigna Medicare Advantage's Risk Adjustment program for assigned populations in an operational market.
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Professional coder certification with credentialing from AHIMA and/or AAPC (CCA, CCS, RHIA, RHIT, CPC-H/COC, CIC, CCS-P, CPC, and CPC-A) to be maintained annually. Understand the Medicare Ambulatory Payment Classification (APC) codes.
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One of the following certifications are required: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist-Physician-based (CCS-P), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA.
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Certification examples: RHIA Certified Professional Coder (CPC, CCS-P), Certified Hospital Coder (CCS- H) Certified Medical Compliance Officer (CMPO), Certified Professional Medical Auditor (CPMA), HCCA Compliance (CHC), etc.
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