PACE Medical Coding Lead (Hybrid)

Position Summary :

The PACE Medical Coding Lead will review clinical documentation and diagnostic results as necessary to verify the appropriate assignment of the ICD-10 CM, CPT and HCPCS codes as per Official Guidelines for Coding and Reporting. While reporting to the PACE Coding Manager, will work collaboratively to perform coding training, audits, research, and assist with special projects.

This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum expectation to work on-site at least once per month; additional on-site presence may be required based on business need

Essential Functions of the Job :

• Performs coding training, coding audits, provider audits, research, scheduling, and special projects assigned by the PACE Coding Manager
• Responsible for monitoring coding work queues, including deployment of coders to areas of greatest need
• Assist with education in-services for physicians, other providers and clinical staff relating to documentation, coding and charging guidelines
• Perform research, run various reporting and assist with general coding as needed and as requested
• Monitor coding operations with respect to workflows and regular reporting : evaluate workflows for maximum efficiencies and problem solve work queue issues when accounts / charges are not flowing properly, making recommendations as necessary
• Maintain updated documentation of all workflows
• Codes complicated medical charts exceeding 50 diagnoses
• Determines all HCC codes associated with patient encounters
• Keeps up to date with the latest CMS risk adjustment guidelines
• Reviews Chart Progress Notes, patient documentation for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers
• Verifies all diagnostic procedural codes from the electronic health record using ICD-10 CPT and HCPCS coding classifications
• Communicates effectively with providers concerning documentation to assure proper coding and reimbursement
• Identifies all chargeable items within each progress note to ensure proper CPT / HCPCS codes for each of the items
• Applies sequencing guidelines for the diagnosis codes and selection of the principal diagnosis and procedure according to ICD-10 guidelines
• Tracks open / close encounter reports to assure that all patients seen in the clinic are properly coded
• Organizes & prioritizes all work to ensure that records are coded in time frames that will be in line with department policies
• Maintains knowledge of Anatomy & Physiology to interpret general medical classifications for coding including the most complicated encounters / cases
• Acts as an expert resource person to other coders & personnel in other departments regarding coding questions & issues
• Participates in ongoing education, including in-service training and other activities to maintain and improve competence
• Adheres to SYHC's Core Competencies and professional Code of Conduct Behavior Standards in their day-to-day work by consistently demonstrating the Core Values of Respect, Excellence, Integrity and Empowerment

Additional Duties and Responsibilities :

Job Requirements

Experience Required :

Education Required :

Certifications Required :

Verbal and Written Skills Required to Perform the Job :

Technical Knowledge and Skills Required to Perform the Job :

Equipment Used :

Working Conditions and Physical Requirements :

Universal Requirements :

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

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Salary : $29 - $38