HCC Medical Coding Specialist (CCS-P or CPC) – Managed Care
San Antonio, TX
** Position is available as Direct Hire/Permanent, or as a CONTRACT or CONTRACT-TO-HIRE role,
HCC Coder Job Summary:
depending on what works best for each Candidate's situation! **
* Position is IN-OFFICE / ON-SITE in San Antonio Office! *
HCC Coder Background:
- The HCC Auditor/Coder will review medical records for accurate code selection, to include highest level of specificity, documentation validation, compliance with ICD-10 coding guidelines, and quality of care opportunities.
- Reviews outpatient medical records on both a retrospective and prospective basis to ensure documentation accurately reflects and supports code selection based on the ICD-10 coding guidelines, which are submitted to CMS for reimbursement based on the CMS Hierarchical Condition Categories (HCC) applicable to Medicare Risk Adjustment reimbursement initiatives.
- Performs physician queries as needed in order to validate ICD-10 diagnosis codes and follows established physician query policy and procedure.
- Ensures the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted CMS timeframe.
- Safeguards medical records and preserves the confidentiality of personal health information.
- Keeps current on changes in coding and reimbursement requirements for government programs and other third party payers.
- Ensures compliance with all applicable Federal and State laws and regulations related to coding and documentation guidelines for Risk Adjustment.
- Requires Certified Coding Specialist-Physician (CCS-P) or Certified Professional Coding (CPC).
- Around 3 years of a variety of coding and auditing experience.
- At least 1 year Hierarchical Condition Category (HCC) coding experience.
- Possess medical knowledge, skills and abilities to identify non-compliance in areas of coding practices and medical record documentation.
- Proficient knowledge of CMS-HCC Model and guidelines; advanced knowledge of ICD-9-CM, ICD-10-CM, CPT and HCPCS coding, medical terminology and regulatory requirements are required.
- Experience with Electronic Medical Records / Electronic Health Records (EMR/HER) is required.
- Risk Adjustment methodology experience preferred.
- Must be willing and able to work in-office, on site in San Antonio