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 well-being of individuals in need, particularly within Black and Brown communities. Our dedicated team of local physicians, nurses, and caregivers collaborates to provide comprehensive care that goes beyond mere symptom treatment. We strive to eliminate barriers by offering personalized care in the most accessible settings, often in-home, recognizing that understanding our Family Members' race, culture, and environment is vital for achieving better health outcomes. By equipping Family Members, providers, and caregivers with necessary support, we aim to transform health and care into a reality rather than a burden.

Position Summary

The Quality Coding Specialist will report directly to the department manager of risk adjustment, holding the responsibility for strategic planning, analytical judgment, and evidence-based evaluations to influence decisions that align with CINQCARE's standards. The candidate should embody 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 discrepancies in coding, validate coding accuracy, and support departmental reporting.
  • Review medical records to ensure adherence to CINQCARE's coding procedures and compliance with CMS regulations.
  • Adhere to CMS guidelines and best practices in coding.
  • Ensure diagnoses are coded with the highest specificity in medical records and claims.
  • Verify that data from clinicians and subcontractors contains accurate codes that support diagnoses for CMS payment.
  • Provide updates to leadership regarding any coding of invalid codes.
  • Complete necessary documentation and system entries related to encounter coding.
  • Collaborate on any inquiries related to coding.
  • Stay informed about coding changes to maintain current knowledge.
  • 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 stakeholders.
  • Comply with HIPAA regulations, Diversity Principles, Corporate Integrity, and Compliance Program policies.
  • Ensure confidentiality of company information.
  • Maintain communication with management regarding 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 (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 processes.
  • Entrepreneurial Spirit: A commitment to addressing longstanding gaps in care delivery for Black and Brown populations.
  • Communication Skills: Strong verbal and written communication abilities, analytical skills, and presentation capabilities; proficient in Microsoft Office and familiar with EMR platforms.
  • Relationship Management: Ability to cultivate and manage relationships with clinical and business leaders and external stakeholders.
  • Company Culture Fit: Strong judgment, ethical standards, and a collaborative team player with a desire to thrive in a dynamic, fast-paced environment.

Requirements:

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

Compensation: $25 - $27 hourly.

Work Environment: This role requires extended periods of sitting and working on a computer, with regular communication via telephone and email. Proficiency in using common office equipment is essential.

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