Job Description

Job/Position Summary:

Identify, collect, assess, monitor, and document claims and encounter coding information as it pertains to Medicare and Medicaid. Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. Review medical record information to identify all appropriate coding based on CMS HCC categories and CMS documentation and Support Guidelines. Support and participate in prospective and retrospective MRA Reviews.

Essential Functions & Responsibilities

Essential Functions & Responsibilities:

·         Review medical record information to identify all appropriate coding based on CMS HCC categories

·         Complete appropriate paperwork/documentation/system entry regarding claim/encounter information

·         Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards

·         Provide real time support and coordination with Primary Care Providers and Care Coordinators for Medicare Risk Adjustment (MRA) coding, HEDIS and STARS

·         Monitor coding changes to ensure that most current information is available

·         Accurately code encounters on a timely basis

·         Researching and addressing code questions for multiple provider offices as directed

·         Due to the nature of this position, it is understood that coding requirements are expected to change; therefore, participation in affiliated classes and individual efforts to maintain current knowledge of these changes is required

·         Complies with HIPAA regulations.

·         Excellent communication, Customer Service, and telephone skills

·         Strong organizational skills and ability to multi-task effectively.

·         Detail oriented and able to work efficiently in a stressful environment.

·         Strong sense of teamwork.

·         Able to respect and always maintain patient confidentiality.

·         Ability to work within the HN1 system (GDS)

·         Ability to work independently.

·         Ability to follow policies and procedure

·         Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.

·         Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.

·         Compliance with all personnel policies and procedures.

·         Perform additional duties and related essential duties as assigned.

Required Education and Experience

Required Education and Experience:

• High School Diploma or equivalent
• Minimum 2 years’ experience in MRA environment
• Bi-lingual English/Spanish preferred; must be able to read, write and speak English.
• Customer Service Skills.
• Ability to communicate effectively with physicians and other clinical professional staff
• Proficient with Microsoft Outlook, Word, and Excel
• Strong people skill, independent decision making and customer service oriented.
• Expertise Knowledge of medical terminology and Anatomy
• ICD, CPT, and HCPS knowledge, preferred