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Quality Coding Specialist

3 months ago

Buffalo, United States CINQCARE Full time
Job DescriptionJob Description

Quality Coding Specialist

CINQ Connect NY LLC

Position Description

Overview

The Quality Coding Specialist will work closely and report to the department manager of risk adjustment ith accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQCARE requirements. They should embody CINQCARE’s core values, including, Trusted, Empathetic, Committed, Humble, Creative and Community-Minded. At CINQCARE, we don’t have patients or customers – we have Family Members.

The Quality Coding Specialist will work closely with providers, nurse practitioners, and other care team members. This position is responsible for reviewing the documentation of the clinicians, subcontractors with the goal of closing Risk Adjustment gaps, closing HEDIS care gaps, and claims reconciliation. 

Primary Responsibilities

The Quality Coding Specialist worker will have the following responsibilities: 

  • The Quality Coding Specialist is responsible for researching, and analyzing the medical records for discrepancy in coding, validating the coding, and supporting the department in the reporting of findings.
  • This position reviews medical records to ensure compliance with CINQCARE coding procedure and standards according to regulations from CMS.
  • Coder must follow CMS, and best practice guideline.
  • Coder will confirm the diagnoses information is coded to the highest level of specificity within the medical records and on the claims reviewed.
  • Ensure that sources of data from clinician, and subcontractors has the correct code and support the diagnoses within the medical record in order to ensure payment from CMS.
  • Provide leadership updates on all coding of invalid codes.
  • Complete appropriate paperwork, documentation, system entry regarding coding of encounter information
  • Provide collaboration efforts with any coding related inquiries.
  • Monitor coding changes to ensure that the most current information is available
  • Maintain thorough knowledge of coding audit guidelines and procedures, medical terminology, anatomy, ICD10 CM coding, and transactions for accessing data.
  • Communicate and interact effectively and professionally with management, co-workers, customer etc.
  • Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable corporate and departmental policies.
  • Maintain complete confidentiality of company business.
  • Maintain communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
  • Perform other job-related duties as assigned.  

Qualifications

The Quality Coding Specialist should have the following qualifications:

  • Education:
    • High School Diploma or HSE. Associate or bachelor’s degree, preferred.
    • Active Coding Certification, AAPC/AHIMA- CPC, COC, CPMA, CDEO, CRC, CCS, CCS-P, CCDS, required.
  • Experience: At least two to five years of medical coding, auditing experience on Risk Adjustment for Medicare and Medicaid or Retail Exchange business experience with process management.
  • Entrepreneurial. CINQ seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQ is positioned to innovatively deliver on its promise
  • Communication. Excellent verbal, written communication, analytical, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQ’s team, investors, partners, and other stakeholders. Proficiency in all Microsoft Office applications as well as familiarity and willingness to learn EMR platforms
  • Relationships. Ability to build and effectively manage relationships with clinical and business leaders and external constituents
  • Culture. Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial Company.

Requirements:

  • Active Coding Certification
  • 2-5 years of Coding experience
  • Auditing experience on Risk Adjustment for Medicare and Medicaid.

Compensation: $25- $27 hrly.

Location:  Hybrid- Buffalo, NY

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