What are the responsibilities and job description for the Inpatient/Outpatient Coder position at MetroPlusHealth?
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health Hospitals
MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
The Inpatient / Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for : physician documentation, clinical evidence that supports the diagnoses, medical necessity of procedures, appropriate setting of care and accurate use of CMS coding guidelines.
Job Description
- Identifies trends and inconsistencies in provider documentation and coding practices.
- Audits and reviews medical records to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy.
- Develops curriculum to improve provider coding practices.
- Educates providers and their practice staff in coding guidelines.
- Works in collaboration with other departments, develop plans and materials that support education and system changes to ensure proper coding is a standard practice for all providers.
- Participates in the review and analysis of summary data. Assist with data collection and report generation.
- Maintains the confidentiality and security of sensitive information and files.
Minimum Qualifications
Licensure and / or Certification Required
Professional Competencies
LI-Hybrid
MPH50
