Medical Coder

T.H.E. CLINIC, INC.JOB DESCRIPTIONPOSITION : HCC CODERDEPARTMENT : Information TechnologySTATUS : Full-Time, Non-ExemptPOSITION SUMMARY : Conduct the necessary audits of medical record to verify the physicians have appropriatelydocumented the diagnoses then code these diagnoses in ICD-10 for Medicare RiskAdjustments / Medicare Advantage. Evaluate medical information (Outpatient / Inpatient)documentation from a clinical standpoint for evidence of the possibility of additional medicalconditions that may not have been documented in the past, and ensure accurate coding ofthe encounter data and recommend processes for accurate coding practices. This processinvolves a very strong understanding of medical coding.Essential Duties and Responsibilities : - Ascertain that medical record documentations have accurate diagnoses and conditionsto assure not to up-code, fraudulently or misrepresent the patient condition and ensurecompliance to prepare for random CMS medical records audit- HEDIS coding and record collection- Report Coding discrepancies patterns identified within the chart review process to theCoding Project Manager and identify corrective measures regarding complianceproblems, and suggests corrective measure to the physician in understanding of what isneeded regarding documentation compliance1. Provider Education : - Provide detailed summary to make adjustments to correct improperly paid claimsand document the correct coding to be utilized2. Management Feedback : - Communicate quality issues to direct supervisor & COO, Team Leaders and otherManagers.- Provide recommendations to management based on audit findings3. Management reports : - Prepare management summary reports of audit findings4. Additional Responsibilities : - Provide support to the Management as required.- Maintains detailed knowledge of coding guidelines and regulationsQualifications and / or Experience Requirements : - Must have CPC or CCS certification- Five (5) years coding experience.- Multi-Specialty coding experienced required.- Outpatient / Clinic billing experience required.- Physician billing office supervisory experience preferred- Knowledgeable in Hierarchical Condition Categories (HCC) concepts and documentationguidelines.- Knowledge in MACRA reporting- Participate in Quality Improvement and other research projects as directed.- High School degree required. Some college preferred.