Quality Assurance Coding Analyst

2 weeks ago

Marietta, Georgia, United States CINQCARE Full time
Job Overview

About CINQCARE

CINQCARE is a community-driven health and care partner focused on enhancing the health and wellness of individuals requiring care, particularly within Black and Brown communities. Our dedicated team of healthcare professionals collaborates to provide comprehensive care that goes beyond mere symptom management. We prioritize personalized care, often delivered in-home, recognizing that understanding our Family Members' cultural and environmental contexts is essential for achieving better health outcomes. By equipping Family Members, providers, and caregivers with necessary resources, we aim to transform health and care into a supportive experience rather than a burden.

Position Summary

The Quality Coding Specialist will report directly to the department manager of risk adjustment, playing a pivotal role in shaping strategies, exercising sound judgment, and conducting evidence-based analyses to meet CINQCARE's standards. This role embodies CINQCARE's core values: Trust, Empathy, Commitment, Humility, Creativity, and Community Focus. At CINQCARE, we prioritize our Family Members over traditional patient or customer labels.

Key Responsibilities

  • Conduct thorough research and analysis of medical records to identify coding discrepancies, validate coding accuracy, and support departmental reporting.
  • Review medical records to ensure adherence to CINQCARE's coding procedures and compliance with CMS regulations.
  • Follow CMS guidelines and best practices diligently.
  • Ensure diagnoses are coded with the highest specificity in both medical records and claims.
  • Verify that data from clinicians and subcontractors is accurately coded to support diagnoses for CMS payment.
  • Provide leadership updates regarding the coding of invalid codes.
  • Complete necessary documentation and system entries related to encounter coding.
  • Collaborate on any coding-related inquiries.
  • Stay informed on coding changes to ensure access to the latest information.
  • Maintain a comprehensive understanding of coding audit guidelines, medical terminology, anatomy, ICD10 CM coding, and data access transactions.
  • Communicate effectively and professionally with management, colleagues, and external stakeholders.
  • Adhere to HIPAA regulations, Diversity Principles, Corporate Integrity, and Compliance Program policies.
  • Maintain confidentiality regarding company business.
  • Keep management informed about developments in assigned areas and undertake special projects as needed.
  • Perform additional job-related duties as assigned.

Qualifications

  • Education:
    • High School Diploma or equivalent; Associate or Bachelor's degree preferred.
    • Active Coding Certification from AAPC/AHIMA (CPC, COC, CPMA, CDEO, CRC, CCS, CCS-P, CCDS) is required.
  • Experience: A minimum of two to five years in medical coding and auditing, specifically in Risk Adjustment for Medicare and Medicaid or Retail Exchange business.
  • Entrepreneurial Spirit: CINQCARE seeks to address long-standing gaps in care delivery for Black and Brown populations, and this role is crucial in ensuring innovative solutions.
  • Communication Skills: Strong verbal and written communication abilities, analytical skills, and presentation capabilities; adept at conveying concepts clearly to various stakeholders. Proficiency in Microsoft Office and willingness to learn EMR platforms is essential.
  • Relationship Management: Ability to cultivate and manage effective relationships with clinical and business leaders as well as external partners.
  • Company Culture: Demonstrated good judgment, strong ethics, and a collaborative team spirit; a desire to thrive in a dynamic and demanding environment.

Requirements:

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

Compensation: $25 - $27 hourly.

CINQCARE offers healthcare benefits to employees working an average of 30+ hours per week, with costs shared between the company and employees.

Working Environment: This role involves extended periods of sitting at a desk and using a computer, with regular communication via telephone and email. Good manual dexterity for office equipment is necessary, along with the ability to interpret management reports and documents.

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