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Senior Professional Coder

2 months ago

Newark, United States Rangam Consultants Inc. Full time

Location: Remote (Client is accepting resumes from NY, NJ, PA, DE, CT)


Summary:

  • The Senior Professional Coder provides services to perform code abstraction using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures.
  • HCC Risk Adjustment Coders will be involved with activities of code abstraction for the following programs; including but not limited to, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, Commercial IVA (Initial Validation Audit), and Medicare RADV (Risk Adjustment Data Validation).
  • HCC Risk Adjustment Coders are required to maintain minimum 95% accuracy on coding quality audits.


Qualifications:

  • Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist , P from the American Health Information Management (AHIMA)
  • Requires 5+ years of Medical Coding experience
  • Requires a minimum of 5+ years’ experience in Health Insurance/quality chart audits and/or Utilization Review
  • Bachelor's degree required


Knowledge:

  • Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding
  • Requires knowledge of medical terminology of medical procedures, abbreviations and terms
  • Requires knowledge of the health care delivery system


Skills and Abilities:

  • Requires the ability to utilise a personal computer and applicable software (e.g. proficiency in Word and Excel)
  • Must have effective verbal and written communication skills and demonstrate the ability to work well within a team
  • Must demonstrate professional and ethical business practices, adherence to company standards and a commitment to personal and professional development
  • Proven ability to exercise sound judgement and problem solving skills
  • Proven ability to ask probing questions and obtain thorough and relevant information


Responsibilities:

  • Compile chart review findings statistics, analyse data results and implement meaningful action plans that improve providers’ performance levels
  • Education new staff to produce and maintain high quality data abstraction and chart reviews
  • Develop quality assurance processes to ensure data integrity of all submitted diagnoses to regulatory agencies and key stakeholders
  • Evaluate and improve the effectiveness of risk adjustment coding programs, policies & procedures and work flow
  • Work closely with inter-departmental team management to support coding initiatives related to risk adjustment programs
  • As a Subject Matter Expert, this person will support risk adjustment coding initiatives to identify opportunities to enhance and grow business
  • Responsible for educating and keeping management informed on current changes in regulations/guidance related to ICD-10 coding and quality documentation and reporting
  • Interface with operations and clinical leadership to assist in identification of coding & documentation improvements and promote best practices
  • Conduct mock audits or surveillance activities that target problematic diagnoses as identified by CMS and internal stakeholders
  • Can understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.
  • Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations.
  • Maintains department productivity and accuracy standards.