“Sanitas is a global healthcare organization expanding across United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.”
Job SummaryThe Medicare Coder Specialist facilitates modifications to clinical documentation through pre visit and post visit interaction with providers and other members of the healthcare team. He or she promotes capture of clinical severity (later translated into coded data) to support the level of service rendered to relevant patient populations, enhance evidence-based medicine, promote continuity of care, improve capturing chronic conditions. Responsible for coding all medical services procedures CPT and HCPCS codes, pharmaceuticals supplies, patients’ ICD-10 diagnoses, signs, and symptoms when applicable, ensuring that all assigned ICD-10-CM codes are supported by proper clinical documentation
Essential Job FunctionsReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Clinically evaluate how the health record translates into coded data, including review of provider and other clinician documentation, lab results, diagnostic information, and treatment plans
• Daily review of outpatient medical records during pre-visit and post-visit review. Communicate with providers either through discussion or in writing (e.g., formal queries) regarding missing, unclear, or conflicting health record documentation, and clarify the information as warranted.
• Communicate with appropriate clinical team members to promote accurate and complete documentation of diagnoses and/or procedures in the health record that have direct bearing on plan of care.
• Gather and analyze information pertinent to documentation findings and outcomes and use this information to develop action plans for process improvement.
• responses have been appropriately documented.
• Collaborate with HIM/coding professionals to review individual problematic cases and ensure accuracy of final coded data in conjunction with CDI managers, coding managers, and/or physician advisors.
• Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization.
• Develop provider education strategies to promote complete and accurate clinical documentation and correct negative trends.
• Identify patterns, trends, variances, and opportunities to improve documentation review processes.
• Enhance expertise in query development, presentation, and standards (including an understanding of published query guidelines and practice expectations for compliance).
• Conduct independent research to promote knowledge of clinical topics, coding guidelines, regulatory policies and trends, and healthcare economics.
• Support any ongoing program that minimizes any organizational risk in the event of a Risk Adjustment Data Validation (RADV) Audit.
• Educates providers on HCC Coding and clinical documentation requirements related to Risk Adjustment. Works with Suspect and dropped reports.
• Comply with HIPAA and code of conduct policies.
• Interact with appropriate resources that support growth and education of the CDI team.
• Utilize the clinic’s designated clinical documentation system to conduct reviews of the health record and identify opportunities for clarification.

Supervisory Responsibilities
This position has no supervisory responsibilities
Required Education

• IMG, foreign physician, or RN with two years of outpatient experience, primary care setting.

Required Experience

• 3-5 years of experience in Medical Coding (ICD-10, CPT, HCPC), Risk Adjustment prospective and retrospective review; and HEDIS/Stars experience.
• Advanced clinical expertise and extensive knowledge of complex disease processes with broad clinical experience in an outpatient setting.

Required Licenses and Certifications

• Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC).

Required Knowledge, Skills, And Abilities

• Strong understanding of ICD-10-CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models.
• Strong understanding of pre visit and post visit review.
• Must be able to read, write and speak English.
• Advance level of proficiency in MS Office - Excel, PowerPoint, and Word. Ability to defend coding decisions to both internal and external audits.
• Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines.
• Must be able to follow policies and procedures.

Preferred Qualifications

• Excellent presentation and analytical skills and must be able to follow procedures.
• Ability to understand, interpret and abstract data/documentation.
• Able to work independently and make decisions effectively in a stressful environment.
• Ability to take initiative and manage different tasks with quick turnaround time.
• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC) and Certified Professional Medical Auditor (CPMA).

Financial Responsibilities
None of the above - This position does not currenlty handle physical money or negotiate contracts
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Budget Responsibilities
This position does not currently have Budget Responsibility
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Languages
English
Advanced
Spanish
Advanced
Creole
N/A
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Travel
RequiredClick or tap here to enter text.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job the employee is regularly required to work standing up, walk, use hands to operate tools and equipment and must be able to exert regularly up to 10 pounds of force, frequently exert 30 pounds of force and occasionally exert 50 pounds of force to constantly perform the essential job functions. The employee will be frequently required to reach with hands and arms, bend, balance, kneel, crouch, crawl, push, and pull. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.
Environmental Conditions
Inside: The employee is subject to environmental conditions, protection from weather conditions but not necessarily from temperature changes. The worker is subject to noise; there may be sufficient noise to cause the worker to shout in order to be heard above ambient noise level.
Physical/Environmental Activities
Please indicate with an X the frequency for the activities that apply to the essential functions of the job based on the chart below. Please select Not Required for physical demands that aren’t essential to job performance.Working Condition
Not Required
Occasionally
(1-33%)
Frequently
(34-66%)
Constantly
(67-100%)
Must be able to travel to multiple locations for work (i.e.
travel to attend meetings, events, conferences).
X
May be exposed to outdoor weather conditions of cold,
heat, wet, and humidity.
X
May be exposed to outdoor or warehouse conditions of loud.
noises, vibration, fumes, dust, odors, and mists.
X
Must be able to ascend and descend ladders, stairs, or other equipment.
X
Subject to exposure to hazardous material.
X
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of the company. Since no job description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, duties and responsibilities that may be inherent in a job, reasonably required for its performance, or required due to the changing nature of the job shall also be considered part of the jobholder’s responsibility.