HCC Certified Coder

This is a fully remote position, open to applicants in United States.

📋 Description

• Abstract clinical data and assign the appropriate diagnosis and procedure codes in line with nationally recognized coding standards.

• Analyze and interpret medical and clinical diagnoses while adhering to the CMS Risk Adjustment Models.

• Collaborate effectively with the coding team and healthcare providers.

• Conduct audits of patient health assessments, peer coding quality reviews, and provide training and education for both providers and the coding team.

• Execute medical chart audits on a prospective basis to identify, monitor, and document claims and encounter coding information related to Hierarchical Condition Categories (HCC).

• Carry out coding abstraction and medical chart quality audits to guarantee that clinicians maintain accurate clinical documentation supporting ICD-10 codes while complying with CMS Risk Adjustment guidelines.

• Educate clinicians on specific coding issues identified in their charts, ensuring they remain informed of coding and documentation standards.

• Uphold a coding accuracy rate of 95%.

• Meet production targets consistently.

• Perform coding accurately and promptly (CPT, ICD-9, ICD-10, HCPCS, modifiers).

• Exhibit advanced understanding of medical terminology, anatomy, and physiology.

• Provide timely communication with providers regarding opportunities for clinical documentation improvement and inquiries.

• Identify trends through data analysis or chart reviews, assess existing policies for accuracy, and develop new policies while recommending solutions to achieve objectives.

• Stay updated on mandated regulatory, documentation, and coding guidelines, demonstrating proficiency across all aspects of CPT, ICD-10, and HCPCS coding.

• Assign, audit, and educate on E/M coding.

• Conduct quality audits, education, and training sessions for the coding team.

• Collaborate closely with leadership to develop coding tools for the coding team and providers.

• Perform additional duties as required or assigned.

⛳️ Requirements

• Required credentials include CPC, CCS, or CCS-P.

• CRC credentials are also required.

• A minimum of 3 years’ experience in a Certified Coder role is necessary.

• At least 3 years’ experience in HCC coding is essential.

• Familiarity with Athena is an advantage.

• Experience in medical billing is a bonus.

• Background in coding for Nephrology is a plus.

• Proficiency in using a PC in a Windows environment, including Microsoft Word, Excel, PowerPoint, and Electronic Medical Records, is required.

• Experience in communicating and collaborating closely with Physicians is important.

• Knowledge of Medicare programs and regulations, including fraud and abuse as well as Risk Adjustment, is necessary.

• Familiarity with STARs performance measures and metrics is preferred.

🏝️ Benefits

• Opportunity to work within a dynamic, fast-paced, and innovative value-based provider organization that is revolutionizing kidney care delivery.

• Competitive salary with the opportunity to participate in the company’s bonus program.

• Comprehensive medical, dental, vision, and life insurance coverage.

• Flexible paid leave and vacation policy.

• 401(k) plan with matching contributions.