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 in need, particularly within Black and Brown communities. Our dedicated team of healthcare professionals collaborates to provide comprehensive care that extends beyond mere symptom management. We strive to eliminate barriers by offering personalized care in the comfort of home, recognizing that understanding our Family Members' cultural and environmental contexts is vital for achieving better health outcomes. By equipping Family Members, providers, and caregivers with necessary resources, we aim to transform health and care into a seamless experience.

Position Summary

The Quality Coding Specialist will collaborate closely with the department manager of risk adjustment, bringing strategic insight, organizational skills, and evidence-based analysis to support CINQCARE's objectives. This role requires a commitment to 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 assist in reporting findings.
  • Review medical records to ensure adherence to CINQCARE's coding procedures and compliance with CMS regulations.
  • Ensure that coding aligns with CMS guidelines and best practices.
  • Confirm that diagnostic information is 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 updates to leadership regarding any coding issues related to invalid codes.
  • Complete necessary documentation and system entries related to coding encounters.
  • Facilitate collaboration on any coding-related inquiries.
  • Stay informed on coding changes to ensure access to the most current information.
  • Maintain a comprehensive understanding of coding audit guidelines, medical terminology, anatomy, ICD10 CM coding, and data access transactions.
  • Engage professionally with management, colleagues, and external stakeholders.
  • Adhere to HIPAA regulations, Diversity Principles, Corporate Integrity, and Compliance Program policies.
  • Maintain confidentiality regarding company operations.
  • Communicate developments within assigned responsibilities to management and undertake special projects as needed.
  • Perform additional job-related duties as assigned.

Qualifications

  • Education: High School Diploma or equivalent required; Associate or Bachelor's degree preferred. Active Coding Certification (AAPC/AHIMA - CPC, COC, CPMA, CDEO, CRC, CCS, CCS-P, CCDS) is mandatory.
  • Experience: Minimum of two to five years in medical coding and auditing, specifically in Risk Adjustment for Medicare and Medicaid.
  • Entrepreneurial Spirit: A commitment to addressing longstanding gaps in care delivery for Black and Brown populations.
  • Communication Skills: Exceptional verbal and written communication abilities, with proficiency in Microsoft Office and a willingness to learn EMR platforms.
  • Relationship Management: Ability to build and maintain effective relationships with clinical and business leaders.
  • Company Culture: Strong ethical standards, good judgment, and a collaborative team player mentality.

Requirements:

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

Compensation: $25 - $27 per hour.

Work Environment: This role involves extended periods of sitting and computer use, with regular communication via telephone and email. Proficiency in handling office equipment is necessary, along with the ability to interpret management reports and documents.

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