Job Description

Job Description

Job Description

Job Description

• Identifies trends and inconsistencies in provider documentation and coding practices.
• Audits and reviews medical records to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy.
• Develops curriculum to improve provider coding practices.
• Educates providers and their practice staff in coding guidelines.
• Works in collaboration with other departments, develop plans and materials that support education and system changes to ensure proper coding is a standard practice for all providers.
• Participates in the review and analysis of summary data. Assist with data collection and report generation.
• Maintains the confidentiality and security of sensitive information and files.

Minimum Qualifications

• Associates degree required.
• 3-5 years health care experience in a physician group practice or other ambulatory care setting preferred.
• 1+ years of medical coding experience with demonstrated sustained coding quality.
• In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, APR-DRG/MSDRG and APC/APG prospective payment systems
• Demonstrates advanced knowledge of CPT/HCPS/Revenue Code procedure coding, ICD-9/ICD-10 coding principles and practices.
• Ability to research authoritative citations related to coding, compliance, and additional reporting requirements.
• Demonstrates overall knowledge of claims processing for various insurances both private and government

Licensure and/or Certification Required

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