Risk Coding Specialist

Description

POSITION DESCRIPTION:

Responsible for the accurate and efficient coding of FHC medical records in compliance with all legal regulations and accepted standards.  

DETAILED DUTIES AND RESPONSIBILITIES:

• Review accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications. 
• Audits clinical documentation and coded data to validate documentation supports diagnoses, procedures and all services rendered for reimbursement and reporting purposes.
• Identifies diagnostic and procedural information and reviews physician pending charges for appropriate complexity using CPT coding guidelines.
• Assigns codes for reimbursements and compliance with regulatory requirements utilizing guidelines and following up to date coding conventions.
• Works closely with the Coding Administrator to provide feedback to providers to improve documentation practices.
• Confirm patient demographic, insurance and referring physician information is accurately entered in Intergy.
• Enter all codes, CPT, HCPCS and ICD-10 coding and modifiers in Intergy timely and accurately.
• Follow established checks and balances systems to ensure complete and accurate code capture.
• Review Medicare Local Coverage Determinations (LCDs) and Medicare bulletin updates and Medicare NCCI.
• Serves as coding consultant to providers.
• Keeps abreast of compliance regulations, standards, and directives regarding governmental/regulatory agencies and third-party payers.
• Keeps abreast of standard coding guidelines (including Medicare, Medicaid, Managed Care, HEDIS, and FQHC guidelines).
• Provides updates and status reports to management weekly.
• Other duties as assigned.

Requirements

KNOWLEDGE:

• Demonstrated knowledge of Medicaid, Medicare, and Commercial Insurance rules and procedures in a managed care plan environment
• Medical terminology, CPT, HCPCS and ICD-10 coding and modifier usage required
• Understanding of FQHC billing procedures and Sliding Fee Schedules a plus
• Understand and adhere to all HIPAA guidelines

SKILLS AND ABILITIES:

• 2 years’ Medical Coding experience preferred 
• Certified Risk Coder (CRC) Certification preferred