PURPOSE OF POSITION:
The primary purpose of the Coding Specialist is to provide support to the Risk Adjustment team. The Coding Specialist provides guidance and direction to on-site auditors regarding the proper documentation and coding requirements needed to obtain HCC validation. This position entails contact with all services within PrimeTime including but not limited to Provider Relations, Data Reporting, Medicare Part C reconciliation, HEDIS and Compliance. Must maintain a professional demeanor as a representative of PrimeTime and its provider community by working with the office manager and/or contact person to coordinating remote and/or on-site patient chart audits. This position also serves as a point of contact with the Center for Medicare and Medicaid about target and national Risk Adjustment Data Validations (RADV) audits and coding questions/issues. The Coding Specialist will accomplish this goal by performing the tasks outlined above.
RESPONSIBILITIES & EXPECTATIONS:
- Oversee and conduct documentation and coding audits for PrimeTime enrollees at primary care physician's offices (PCP) or remote access.
- Primary contact in working with Data Reporting to identify potential enrollees and develop Member Problem Lists to define confirmed and suspected HCC's for review.
- Assists Data Reporting in maintaining RAPS submission and developing Encounter Data System.
- Develop procedures to identify, document and report HCC additions, changes and deletions to CMS based on approved ICD-CM coding guidelines for both inpatient and outpatient settings.
- Liaison to Provider Relations regarding “Pay for Performance” (P4P) provider documentation programs (e.g. Enhanced Encounters).
- Prepare for ICDCM-10 transition and its effect on HCC assignments, additional supporting documentation needed and mapping historical ICD9 codes to ICD10.
- Educate physicians and physician extenders on appropriate documentation in order to support diagnoses submitted on a claim and validated in a RADV audit.
- Develop auditing worksheets and other tools necessary to verify diagnoses assignment for auditors.
- Provide feedback to providers and their staff regarding audit findings and recommendations.
- Participates in Part C calls, establishes, and maintains an IACS certificate to receive CMS updates for MA organizations.
- Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
- Seeks supervisory guidance/approval as appropriate.
- Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
- Promotes and demonstrates professional standards to enhance the development of the department.
- Practices ethical conduct.
- Meets acceptable attendance and punctuality expectations (excluding FMLA)
The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not a detailed description of all the work requirements that may be inherent to this position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
- Education: High School graduate required, prefer Associate Degree in HIT.
- Certification: Must be a Certified Coding Specialist (CCS), Certified Coding Specialist – Physicians (CCS – P), Certified Professional Coder (CPC-P®), Certified Professional Coder – Hospital (CPC - H®) or Registered Health Information Technologist (RHIT).
- Experience: CPT Coding, ICD10 Coding, Medical Terminology, use of Excel spreadsheets, proficiency with Microsoft Office suite.
- Hours of operation, shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary. Primarily business hours Monday through Friday.
- Some travel may be required for which you will be required to use your own automobile with mileage reimbursement as applicable. Occasional work in physician office.
- Sitting/standing/moving about intermittently during working hours.
- Subject to frequent interruptions and changes in priority of duties throughout the day.
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