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Quality Coding Specialist

2 months ago

Marietta, Georgia, United States CINQCARE Full time
About CINQCARE

CINQCARE is a leading provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to Black and Brown communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our Family Members' race, culture, and environment is critical to delivering improved health outcomes. By empowering Family Members, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day.

About the Role

The Quality Coding Specialist will work closely with our department manager of risk adjustment, providing strategic guidance, judgment, organization, and evidence-based analysis to influence decisions and meet CINQCARE requirements. This role embodies our core values, including Trusted, Empathetic, Committed, Humble, Creative, and Community-Minded. At CINQCARE, we don't have patients or customers – we have Family Members.

Key Responsibilities
  • Research and analyze medical records for discrepancies in coding, validate coding, and support the department in reporting findings.
  • Review medical records to ensure compliance with CINQCARE coding procedures and standards according to regulations from CMS.
  • Follow CMS and best practice guidelines.
  • Confirm diagnoses information is coded to the highest level of specificity within medical records and on claims reviewed.
  • Ensure sources of data from clinicians and subcontractors have the correct code and support diagnoses within medical records to ensure payment from CMS.
  • Provide leadership updates on all coding of invalid codes.
  • Complete appropriate paperwork, documentation, and system entry regarding coding of encounter information.
  • Provide collaboration efforts with any coding-related inquiries.
  • Monitor coding changes to ensure 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, coworkers, and customers.
  • 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.
Requirements
  • Active Coding Certification
  • 2-5 years of Coding experience
  • Auditing experience on Risk Adjustment for Medicare and Medicaid
Compensation and Benefits

CINQCARE provides competitive compensation and benefits, including healthcare benefits for employees working an average of 30+ hours/week. The cost of healthcare is shared between the company and the employee.

Working Environment

This position requires prolonged periods of sitting at a desk and working on a computer. Regular use of the telephone and email for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.