Senior Professional Coder

Summary:
The Senior Professional Coder provides services to perform code abstraction using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. HCC Risk Adjustment Coders will be involved with activities of code abstraction for the following programs; including but not limited to, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, Commercial IVA (Initial Validation Audit), and Medicare RADV (Risk Adjustment Data Validation). HCC Risk Adjustment Coders are required to maintain minimum 95% accuracy on coding quality audits.

Responsibilities:
Compile chart review findings statistics, analyze data results and implement meaningful action plans that improve providers performance levels
Education new staff to produce and maintain high quality data abstraction and chart reviews
Develop quality assurance processes to ensure data integrity of all submitted diagnoses to regulatory agencies and key stakeholders
Evaluate and improve the effectiveness of risk adjustment coding programs, policies & procedures and work flow
Work closely with inter-departmental team management to support coding initiatives related to risk adjustment programs
As a Subject Matter Expert, this person will support risk adjustment coding initiatives to identify opportunities to enhance and grow business
Responsible for educating and keeping management informed on current changes in regulations/guidance related to ICD-10 coding and quality documentation and reporting
Interface with operations and clinical leadership to assist in identification of coding & documentation improvements and promote best practices
Conduct mock audits or surveillance activities that target problematic diagnoses as identified by CMS and internal stakeholders
Can understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.
Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations.
Maintains department productivity and accuracy standards.
Qualifications:
Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist , P from the American Health Information Management (AHIMA)
Requires 5+ years of Medical Coding experience
Requires a minimum of 5+ years experience in Health Insurance/quality chart audits and/or Utilization Review
Bachelor's degree required

Knowledge
Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding
Requires knowledge of medical terminology of medical procedures, abbreviations and terms
Requires knowledge of the health care delivery system


Skills and Abilities
- Requires the ability to utilize a personal computer and applicable software (e.g. proficiency in Word and Excel)
-Must have effective verbal and written communication skills and demonstrate the ability to work well within a team
-Must demonstrate professional and ethical business practices, adherence to company standards and a commitment to personal and professional development
- Proven ability to exercise sound judgment and problem solving skills
-Proven ability to ask probing questions and obtain thorough and relevant information



Disclaimer
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this


Supplier Intake Call Notes:

-100% Remote
- 5 years of Coding- Prefer Senior Coder
- 3-4 Years of Risk Adjustment Coding- Specific details in Resume
-Strong Leadership Skills
-Strong Presentation Skills

-Look for: CMS/ Auditor experience, Quality Assurance, Process Improvements, Multi skilled backgrounds
job.