Certified Medical Coder II - 10445

SUMMARY:

The Certified MRA Coder II will perform Prospective Review and CDI Opportunity Review to assists healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation.  HCC coder will conduct audits to abstract data not submitted by providers and initiate opportunities to improve clinical documentation. Increase accuracy, completeness and compliance with clinical condition documentation to enable providers to deliver quality of care.

RESPONSIBILITIES/TASKS: 

• Ensures compliance with all applicable Federal, laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System. 
• Performs on-site medical record review to capture of all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system. 
• Ensure diagnosis codes are supported by the documentation and ensure adherence with ICD-10CM Guidelines for Coding and Reporting.
• Focus on prospective coding to close HCC gaps and add HCC codes not reported, including the creation of CDI opportunities. 

 This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

High School diploma or equivalent required.  Bachelor’s degree in a related field preferred and/or relevant equivalent and relevant work experience preferred.  Successful completion of a coding license or certificates; CPC, COC, CRC, CCS, CCS-P.  Continuous learning, as defined by the Company’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE: 

Minimum three (3) to five (5) years general coding experience. 

• Minimum of 6 months HCC specific Coding.
• Clinical background preferred.
• Experience and understanding of CMS HCC Risk Adjustment coding and data validation requirements.
• Initial demonstration and maintenance of continuing education/membership is required.
• Experience and understanding of CMS HCC Risk Adjustment coding and data validation requirements. 

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

• Excellent organization and problem-solving skills.
• Strong oral and written communication skills.
• Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology, and concepts of disease processes.
• Extensive knowledge of ICD-10CM coding guidelines.
• Advanced technical skills for use of MS Office (Excel, Word, Outlook, and PowerPoint) as demonstrated through successful completion of a skills test. 
• Demonstrated ability to utilize a variety of electronic medical records systems. 
• Ability to manage a significant work load, and to work efficiently under pressure, while meeting established deadlines with minimal supervision.
• Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization.
• Strong time management skills.
• Must possess a high degree of accuracy, efficiency, and dependability.
• Excellent written and oral communication for representation of clear and concise results.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. 

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. 

 PAY RANGE: 

“Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $50,700 and $84,900.”

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis.  Nothing herein is intended to create a contract.