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Certified Coding Consultant - Full Time - Immanuel Home Office

Immanuel locationOmaha, NE
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100 positions
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Web Mktg Technology Specialist

Immanuel locationOmaha, NE
100 positions
info linkReport a probelm Originally Posted : January 09, 2021 | Expires : February 8, 2021

Details

Salary
Unspecified
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Job Location
Omaha, NE, United States

Description

The overall purpose of this job is to perform accurate and timely review and validation of Hierarchical Conditional Category (HCC’s) through medical record review. The responsibilities of this job include review of medical records for Immanuel Pathways to ensure accurate and complete documentation is maintained, while adhering to coding standards and Centers for Medicare and Medicaid Risk Adjustment Guidelines. This position oversees the medical coding structure and ongoing consultation and advising associated with documentation and coding. Supports and lives out Immanuel’s Mission and CHRIST Promises.

Key Areas

Key Responsibilities and Duties of the Job

Consulting & Advising 45%

  • Provides consultation to all specialties (i.e., PT/OT/PCP/SW) for detection of secondary complications and co-morbid conditions.
  • Provides training and educational materials for all specialties that document for Risk Adjustment.
  • Utilizes knowledge of coding principles to educate all specialties on documentation and coding to ensure the highest level of specificity and compliance with CMS regulations.
  • Provides real-time consultation with providers regarding documentation and coding questions.

Auditing/Monitoring 35%

  • Performs audits and interpretation of medical documentation to capture all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
  • Performs quality reviews and general oversight of coding vendor to ensure all collected data is accurate, complete, and compliant with state and federal regulations as well as the Official Guidelines of Coding and Reporting.
  • Augments consultant auditing to ensure all charts are audited once per year to identify incomplete or missing records and documentation, and ambiguous or nonspecific documentation.
  • Performs reviews for prospective and retrospective audits, yearly.
  • Performs initial assessment review to determine appropriate medical coding from past medical records.

Compliance/Reporting

15%

  • Compiles detailed findings and prepares reports upon completion of coding, medical claims, and documentation audits.
  • Analyzes coding data and errors/irregularities to determine trends and root causes for variations. Provides audit results and shares recommendations for course-correction and education, as needed.
  • Reviews coding reports to ensure ongoing diagnoses are appropriately documented and follows up with all specialties regarding dropped Hierarchical Condition Categories (HCC) and documentation requirements.
  • Analyzes reports to monitor both favorable and unfavorable trends over time and brings the data analysis and recommendations to manager’s attention for discussion and remediation.
  • Analyzes diagnosis codes to detect and prevent Fraud, Waste, and Abuse as it relates to the prescribing of medications.

Other

5%

  • Participates in workgroups/committee meetings and process improvement solutions, as required.
  • Maintains all coding sets within the electronic health record system.
  • Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise.
  • Stays current in changing Medicare/Medicaid regulatory environment and requirements.
  • Performs other duties as assigned or requested.

Education-                                                                                                                                         

  • Associates degree in related field required.
  • Bachelor’s degree preferred.

Experience-

  • Three (3) years of coding experience (except RHIT).
  • Two (2) years of experience with Risk Adjustment Coding (HCC) preferred.
  • Supervisory experience preferred.
  • Experience in training and educational sessions with health care providers for medical documentation and coding.
  • Experience with audit and quality assurance with extensive knowledge and understanding of ICD-10-CM/ICD-10-PCS, CPT-4, HCPCS Level II, coding systems, medical terminology, abbreviations, anatomy, physiology and disease.

Other Requirements –

  • Professional Medical Coder Certificate required:
  • Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) Certified.

 

KSA- Knowledge Skills and Abilities-

 

  • Knowledge in reviewing and assigning accurate medical codes for diagnoses,
    procedures, and services.
  • Knowledge of medical coding guidelines and regulations including compliance and reimbursement.
  • Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider diagnosis and services.
  • Skilled in effective and appropriate verbal and written communication.
  • Skilled in the comprehension of written materials.
  • Skilled in the use of computers and ability to type accurately.
  • Ability to chart via Electronic Health Records.
  • Proven experience with basic computer skills (internet, email, Microsoft Office).
  • Ability to think analytically.
  • Ability to listen effectively seeking first to understand, then to be understood.
  • Ability to pay attention to detail.
  • Ability to identify and recommend problem resolution.
  • Ability to work independently with minimum supervision.
  • Ability to be open to change.
  • Ability to quickly troubleshoot issues and make timely decisions using sound logic and good judgment.

Education-                                                                                                                                         

  • Associates degree in related field required.
  • Bachelor’s degree preferred.

Experience-

  • Three (3) years of coding experience (except RHIT).
  • Two (2) years of experience with Risk Adjustment Coding (HCC) preferred.
  • Supervisory experience preferred.
  • Experience in training and educational sessions with health care providers for medical documentation and coding.
  • Experience with audit and quality assurance with extensive knowledge and understanding of ICD-10-CM/ICD-10-PCS, CPT-4, HCPCS Level II, coding systems, medical terminology, abbreviations, anatomy, physiology and disease.

Other Requirements –

  • Professional Medical Coder Certificate required:
  • Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) Certified.

 

KSA- Knowledge Skills and Abilities-

 

  • Knowledge in reviewing and assigning accurate medical codes for diagnoses,
    procedures, and services.
  • Knowledge of medical coding guidelines and regulations including compliance and reimbursement.
  • Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider diagnosis and services.
  • Skilled in effective and appropriate verbal and written communication.
  • Skilled in the comprehension of written materials.
  • Skilled in the use of computers and ability to type accurately.
  • Ability to chart via Electronic Health Records.
  • Proven experience with basic computer skills (internet, email, Microsoft Office).
  • Ability to think analytically.
  • Ability to listen effectively seeking first to understand, then to be understood.
  • Ability to pay attention to detail.
  • Ability to identify and recommend problem resolution.
  • Ability to work independently with minimum supervision.
  • Ability to be open to change.
  • Ability to quickly troubleshoot issues and make timely decisions using sound logic and good judgment.


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