Supervisory Responsibilities
This position has no supervisory responsibilities
Required Education
- IMG, foreign physician, or RN with two years of outpatient experience, primary care setting.
Required Experience
- 3-5 years of experience in Medical Coding (ICD-10, CPT, HCPC), Risk Adjustment prospective and retrospective review; and HEDIS/Stars experience.
- Advanced clinical expertise and extensive knowledge of complex disease processes with broad clinical experience in an outpatient setting.
Required Licenses and Certifications
- Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC).
Required Knowledge, Skills, and Abilities
- Strong understanding of ICD-10-CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models.
- Strong understanding of pre visit and post visit review.
- Must be able to read, write and speak English.
- Advance level of proficiency in MS Office - Excel, PowerPoint, and Word. Ability to defend coding decisions to both internal and external audits.
- Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines.
- Must be able to follow policies and procedures.
Preferred Qualifications
- Excellent presentation and analytical skills and must be able to follow procedures.
- Ability to understand, interpret and abstract data/documentation.
- Able to work independently and make decisions effectively in a stressful environment.
- Ability to take initiative and manage different tasks with quick turnaround time.
- Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC) and Certified Professional Medical Auditor (CPMA).
Financial Responsibilities
None of the above - This position does not currenlty handle physical money or negotiate contracts
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Budget Responsibilities
This position does not currently have Budget Responsibility
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Languages
English
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Advanced
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Spanish
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Advanced
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Creole
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N/A
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Travel
Required
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Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job the employee is regularly required to work standing up, walk, use hands to operate tools and equipment and must be able to exert regularly up to 10 pounds of force, frequently exert 30 pounds of force and occasionally exert 50 pounds of force to constantly perform the essential job functions. The employee will be frequently required to reach with hands and arms, bend, balance, kneel, crouch, crawl, push, and pull. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.
Environmental Conditions
Inside: The employee is subject to environmental conditions, protection from weather conditions but not necessarily from temperature changes. The worker is subject to noise; there may be sufficient noise to cause the worker to shout in order to be heard above ambient noise level.
Physical/Environmental Activities
Please indicate with an X the frequency for the activities that apply to the essential functions of the job based on the chart below. Please select Not Required for physical demands that aren’t essential to job performance.
Working Condition
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Not Required
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Occasionally
(1-33%)
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Frequently
(34-66%)
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Constantly
(67-100%)
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Must be able to travel to multiple locations for work (i.e.
travel to attend meetings, events, conferences).
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X
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May be exposed to outdoor weather conditions of cold,
heat, wet, and humidity.
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X
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May be exposed to outdoor or warehouse conditions of loud.
noises, vibration, fumes, dust, odors, and mists.
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X
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Must be able to ascend and descend ladders, stairs, or other equipment.
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X
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Subject to exposure to hazardous material.
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X
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We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.
This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of the company. Since no job description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, duties and responsibilities that may be inherent in a job, reasonably required for its performance, or required due to the changing nature of the job shall also be considered part of the jobholder’s responsibility.