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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 4 days ago - UpvoteDownvoteShare Job
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Performs HCC coding on projects for MA, ACA, or End Stage Renal Disease (ESRD) through the assignment of appropriate ICD-10 diagnosis codes under the direction of management; may flex between coding projects with different MA, ESRD, or ACA HCC Models.
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Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD-10 diagnoses and HCC disease categories.
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Associate Hierarchical Condition Category (HCC) Coding Specialist. Certified Coding Specialist (CCS) 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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Minimum of three years of experience in medical coding with ICD-10 and CPT coding systems required. The ideal candidate should possess a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) certification and a minimum of 3 years of Inpatient and/or Outpatient coding experience.
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Apply knowledge of inpatient ICD-10 coding guidelines and clinical documentation requirements to assign working MS-DRG.Enter review information and working MS-DRG/APR-DRG's with associated length of stay in the shared information system, and updates this information as needed to reflect any changes in patient's status, procedures and treatments.
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1 year of HCC risk adjustment coding. Associates degree in medical billing/coding, health insurance, healthcare, or related field. 3 years of medical billing/coding, health insurance, and/or healthcare experience.
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Utilizes knowledge of official coding guidelines (ICD-10, CPT, HCPCs), Hierarchical Condition Categories (HCC), M.E.A.T (Monitored, Evaluated/Assessed/Addressed, Treated) standards, Risk Adjustment Factor (RAF) scoring, and AHIMA/ACDIS physician query brief.
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Advanced knowledge of the ICD-10 CM/PCS and CPT/HCPCS coding systems and conventionsAdvanced knowledge of, but not limited to, Official Coding Guidelines and methodologies.
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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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Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making. Works closely with team members, and leadership to identify and deliver high quality and accurate risk adjustment coding.
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Build partnerships and work within coding teams and internal partners critical to HCC coding. Medical Coding or Billing. Engages in coding educational meetings and annual coding summit.
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Achieves and maintains coding productivity and quality accuracy metrics set by the management team. May assist with Regulatory Audits by performing first coding review and ranking of charts.
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Works in various coding applications to support departmental goals. Lifting: up to 10 pounds. Lifting: 10 to 25 pounds. Certified Risk Coder Apprentice (CRC-A) Certified Risk Coder (CRC.
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Act as a resource for network providers for diagnosis coding in ICD.10, CPT coding and risk adjustment methodology. The coders primary responsibilities are to code, abstract and analyze outpatient medical records using ICD.10 and CPT coding guidelines and educate network providers on proper documentation and coding practice.
ExpandApply NowActive JobUpdated 4 days ago
coding specialist icd 10 jobs
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