HCC Coder – Health Plan

Location: Orange, CA
Date Posted: 03-08-2018
HCC Medical Coding Specialist (CCS/CPC/RHIT) – Managed Care
Orange, CA
*** This is a Full-Time, Benefits Available, CONTRACT assignment, expected to last around 5-6 months, or longer! ***

Your Job Summary:
The Medical Coding Specialist (CCS/CPC) performs Hierarchical Condition Category (HCC) coding activities by reviewing medical records and coding with appropriate clinical diagnosis and procedure codes, in accordance with nationally recognized coding guidelines.  The coder provides coding expertise as well as basic administrative oversight to ensure successful integration of initiatives.  Performs chart review, applies applicable medical codes, ensures that all compliance standards are met, and performs adhoc projects as requested. This position will monitor HCC coding performed by outside vendors to ensure accuracy and make corrections as needed.
Your Background:

Requires Certified Coding Specialist (CCS) or Certified Professional Coding (CPC), Registered Health Information Technician (RHIT) preferred.
Requires ICD-10 Coding Certification and demonstrated knowledge of ICD-10 and additional coding categories/types.
Requires Bachelor’s degree in Health Information, or other healthcare fields is a plus.
Around 3-5 years of a variety of coding and auditing experience, with at least 3 years coding at a Managed Care Organization.
At least 3-5 years of Medicare Risk Adjustment Data Validation (RADV) and Hierarchical Condition Category (HCC) coding experience.
At least 1-2 years medical chart auditing / quality review experience required.
Possess medical knowledge, skills and abilities to identify non-compliance in areas of coding practices and medical record documentation.
Advanced knowledge of ICD-9-CM, ICD-10-CM, CPT and HCPCS coding, medical terminology and regulatory requirements are required.
Able to work independently with a high degree of attention to detail and reliable decision-making abilities.
Computer skills necessary to provide accurate medical record reviews and any corresponding documentation of results through remote access. Experience with an encoder preferred.
Experience with Electronic Medical Records / Electronic Health Records (EMR/HER) is required.
Ability to maintain at least a 95% accuracy rate.
Must be willing and able to travel locally.
Position Description:
  • Reviews and analyzes medical information from medical records against billed procedures to apply accurate coding of diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements.
  • Accurately assigns correct principal and secondary codes, primarily Hierarchical Condition Category (HCC) codes, and abstracts pertinent information from patient’s records to ensure codes are assigned.
  • Audit vendors to ensure accurate HCC codes are captured; provide feedback / corrections as needed.
  • Performs a detailed review of the inpatient medical record to verify you have coded each line with the appropriate diagnosis, procedure, and revenue code and that the ICD-9 / ICD-10 diagnosis and procedure codes were coded and sequenced correctly to achieve the appropriate MS-DRG, AP-DRG, or APR-DRG.
  • Responsible for resolving any and all pre-bill edits, denials, etc for assigned accounts.
  • Makes corrections as needed to ensure accurate billing and reimbursement processing; if needed, provides written justification for use by client organizations to adjust claims.
  • Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes.
  • Maintains and helps to disseminate up-to-date technical knowledge of legal / regulatory information, including all ICD-9/10 CM, CPT-4, HCPCS, DRG, APC and/or HHRG updates and changes.
  • For all assigned records assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards. 

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