Sr. Medical Coder

We're Hiring: Sr. Medical Coder!

We are seeking an experienced and detail-oriented Sr. Medical Coder to join our healthcare team. The ideal candidate will have extensive knowledge of medical coding systems, healthcare regulations, and quality assurance processes to ensure accurate coding and compliance with industry standards.

Location: Rochester, NY
Role: Sr. Medical Coder

Responsible for reviewing medical records to abstract ICD10 codes that map to HCCs from a variety of different CMS Hierarchy models including Medicare Advantage, PACE, Commercial, and Medicaid CDPS model. In addition to abstracting diagnosis codes, the Clinical Review Specialist also audits medical records and validates entries that have been submitted to CMS.

RESPONSIBILITIES:

• Conducts audits of medical records (paper, EMR, hybrid)
• Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision.
• Understands, respects, and applies client specific guideline
• Adheres to audit and medical record review schedules to meet client expectations and government-regulated deadlines
• Regularly participates in peer review; provide and receive feedback
• Ensures accurate documentation to support all audits
• Assures adherence to and currency with internal and external regulatory guidelines:
• CMS/HHS
• DOH
• HIPAA, HITECH, and Fraud Waste & Abuse
• Medical coding protocols
• Maintain coding credentials as required by credentialing agency

• Coding Certification: CPC, CCS, RHIT, or RHIA
• Possess at least 5 years of experience of with ICD-9, ICD-10, CPT and HCPC coding systems
• Proficiency in MS Office tools such as Word, PPT, Excel and be comfortable learning and becoming an expert on new and proprietary software

• Have strong written and verbal communication skills, including propensity to establish and build strong relationships.
• Take initiative to establish priorities, coordinate work activities and perform multiple and complex tasks while working independently and with minimal supervision in a remote setting.
• Ability to consistently meet established minimum quality standards in a heavy production environment
• Must be able to meet organization production and accuracy goals
• CRC Certification
• Documentation Improvement experience, experience in Hierarchical Condition Categories (HCC), knowledge of or experience in Medicare Advantage plans and knowledge of or experience in managed health care systems, PACE or Medicare are plusses

Ready to make an impact? 🚀 Apply now and let's grow together!