Medical Coding Analyst
- Review and interpret medical record documentation to identify pertinent diagnoses and procedures and assigns ICD-10 CM and CPT 4 codes accurately and timely to the highest level of specificity based upon physician documentation.
- Verify and ensure the accuracy and completeness of medical records while extracting appropriate and specific ICD-10 CM- CPT and Category II codes.
- Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations.
- Review coding patterns/trends and provides ongoing consultation to the field Quality/ Network Relations team regarding coding and documentation issues.
- Proactively identifies and communicates problems and opportunities; actively recommends and implements solutions or medical coding process improvements.
- Interpret coding rules and general policies in addition to determining appropriate conclusions.
- Determine valid encounters including legibility and valid signature requirements.
- Provide information or respond to questions from medical coding quality audits.
- Possess and maintain a current and comprehensive understanding of coding rules, changes, and guidelines as defined by the AMA.
- Responsible for consistently meeting established quality and productivity standards.
- Other duties relating to coding projects as assigned.
Skills, Knowledge, Abilities
- Experience working in medical coding/auditing with experience in Diagnosis coding
- Knowledge of medical terminology including anatomy and physiology...
- HCC and risk adjustment model experience strongly preferred
- Strong background in ICD 10 Coding
- Knowledge and understanding of CPT and CPT II (HCSPCS) codes
- Intermediate level of experience with Microsoft Excel (Pivot table, building chart)
- Strong written and verbal communication and organizational skills
- Must present active AAPC or AHIMA membership ID #
- Proficient with Excel and MS office products
- Demonstrates the ability to perform in a high productivity fast-paced environment.
- Knowledge of ICD-10 CM Guidelines and CMS Risk Adjustment Guidelines
- Knowledge of Risk Adjustment Coding
- High school diploma or general educational degree (GED), required
- Associate or Bachelor degree in health care discipline, preferred
- Medical coding Credentials through either AAPC or AHIMA (CCS, CCS-P, or CPC) maintained annually, required.
- CRC or CPMA credentials, preferred
- Proficient in navigating an electronic medical record and healthcare billing system
- 3+ years’ of inpatient facility coding experience with both quality and productivity requirements
- 3+ years’ of outpatient facility coding Auditing experience is preferred
- 1+ year of inpatient and/or outpatient facility coding experience
- 1+ year of auditing experience preferred
- Knowledge of Risk Adjustment coding
- 1 year of healthcare provider education experience
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