Certified Coder

Description

Position Summary:

The Certified Coder is a key position in two ways: First, the employee will be responsible for abstracting medical record data and assigning/reviewing codes using current clinical classification systems appropriate for the type of care provided. Second, the employee will be able to review Medicare Risk Adjustment, understanding Medicare Advantage Plans and evaluating medical records with attention to detail.

Requirements

Essential Functions

1. Reviewing and assigning codes to diagnosis and procedures in order to ensure proper financial reimbursement from insurance companies.

1. Applies comprehensive knowledge of medical terminology, anatomy & physiology, disease processes,treatment modalities, diagnostic tests.
2. Assists facility staff with documentation requirements to completely and accurately reflect the patient care provided.
3. Conducts claims audits/reviews, identifying opportunities for improving.

2. The Certified Coder is responsible for performing Risk Adjusted (RA) coding reviews and related analysis to optimize RA coding opportunities throughout primary care.

1. Communicates with physicians and office staff regarding records needed for chart reviews related to the Risk Adjustment process.
2. Serves as a Subject Matter Expert and resource in Clinical Documentation.
3. Performs chart reviews for appropriateness and completeness of diagnostic codes based on CMS HCC categories.
4. Collaborates in the development of coding or risk adjustment tools/training aides for contracted providers and staff.

Additional Duties &Responsibilities:

• Ability to maintain discretion when handling confidential information. Adhere to HIPAA rules and regulations.
• Works in cooperative fashion with other team members.
• Demonstrates proficiency with the practice management system, appropriate to job responsibilities.
• Acts as liaison between Providers and Insurances Companies
• Assists staff training as needed at all levels.
• Acts as intermediary between UCHC and patients when necessary.
• Travels to UCHC clinic locations on an as needed basis
• Participates in inter-disciplinary task forces and work groups as relevant.
• Other duties as assigned.