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Healthcare Coding Analyst
2 months ago
CINQCARE is a community-driven, provider-led organization dedicated to enhancing health and wellness for those in need. Our mission is to eliminate obstacles to health and well-being, delivering care within the community and as close to home as possible, including in-home services.
We recognize the significance of race and culture in achieving effective healthcare outcomes, which is why we incorporate these factors into our care delivery. Our goal is to foster a culture of care that begins with understanding our patients, their needs, and their care plans.
At CINQCARE, we believe that effective care is rooted in local healthcare professionals, caregivers, and services that address the needs of individuals rather than merely treating symptoms.
We strive to provide services in the home whenever feasible, aiming for improved outcomes for individuals and their communities.
CINQCARE is committed to enhancing the health and well-being of those who require our support the most, particularly focusing on Black and Brown populations within their homes and communities.
This mission necessitates a collaborative effort from individuals at all levels of the organization to fulfill our purpose.
We aspire to create a world where health and care are not burdensome, as we view providing care as a privilege—one we are honored to uphold.
About You
The Healthcare Coding Analyst will collaborate closely with the department manager of risk adjustment, providing strategic insights, organizational skills, and evidence-based analysis to influence decision-making and meet CINQCARE's requirements.
This role embodies CINQCARE's core values: Trust, Empathy, Commitment, Humility, Creativity, and Community Orientation. At CINQCARE, we refer to our patients as Family Members.
The Healthcare Coding Analyst will engage with providers, nurse practitioners, and other members of the care team.
This position entails reviewing clinician documentation and subcontractor records to address Risk Adjustment gaps, close HEDIS care gaps, and facilitate claims reconciliation.
Primary Responsibilities
The Healthcare Coding Analyst will be responsible for:
- Conducting research and analysis of medical records to identify discrepancies in coding, validating codes, and supporting departmental reporting.
- Reviewing medical records to ensure adherence to CINQCARE's coding procedures and standards as mandated by CMS regulations.
- Ensuring that diagnoses are coded with the highest level of specificity in medical records and claims.
- Verifying that data from clinicians and subcontractors is accurately coded to support diagnoses, ensuring compliance for CMS payment.
- Providing leadership updates regarding any coding of invalid codes.
- Completing necessary documentation and system entries related to encounter coding.
- Collaborating on any coding-related inquiries.
- Monitoring coding updates to ensure access to the most current information.
- Maintaining a comprehensive understanding of coding audit guidelines, medical terminology, anatomy, ICD10 CM coding, and data access transactions.
- Communicating effectively and professionally with management, colleagues, and other stakeholders.
- Adhering to HIPAA regulations, Diversity Principles, Corporate Integrity, Compliance Program policies, and other relevant corporate and departmental policies.
- Maintaining confidentiality regarding company business.
- Keeping management informed about developments in assigned areas and undertaking special projects as required.
- Performing additional job-related duties as assigned.
Qualifications
The ideal candidate for the Healthcare Coding Analyst position should possess:
Education:
High School Diploma or equivalent; an Associate or Bachelor's degree is 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 of experience in medical coding and auditing, specifically in Risk Adjustment for Medicare and Medicaid or Retail Exchange business, with a focus on process management.
Entrepreneurial spirit: CINQCARE aims to address longstanding gaps in care delivery for Black and Brown populations.
This role is crucial in ensuring CINQCARE's innovative delivery of its commitments.
Communication Skills:
Exceptional verbal and written communication skills, along with analytical and presentation abilities; capacity to clearly convey concepts and models to CINQCARE's team, investors, partners, and other stakeholders.
Proficiency in Microsoft Office applications and a willingness to learn EMR platforms.
Relationship Management:
Ability to build and maintain effective relationships with clinical and business leaders, as well as external stakeholders.
Culture Fit:
Sound judgment, strong ethics, and a collaborative team player; a desire to thrive and advance in a fast-paced, dynamic, and entrepreneurial environment.
Requirements:
Active Coding Certification
2-5 years of coding experience
Auditing experience in Risk Adjustment for Medicare and Medicaid.
Compensation:
$25 - $27 hourly.
Location:
Hybrid work arrangement.