Position Summary

The HCC Coder will be responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with accepted and established standards. The HCC Coder will collaborate with the Billing Manager and Medical Director in providing expertise in the use and application of current coding classifications including but not limited to ICD-10-CM, CPT, E&M and record documentation to ensure compliance in the collection of outpatient diagnoses and services.

Schedule:

• Full-time (Non-Exempt)
• Flexible, may require some evening and weekends

Primary Duties and Responsibilities

• Review of medical records to ensure accuracy and claims for proper documentation and coding and completeness.
• Communicate with providers when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes.
• Create training presentations to educate staff in Medicare coding guidelines, with focus on Quality Measures with focus on HEDIS and Risk Adjustment HCC.
• Lead the development and implementation of special projects such as new processes, policies and procedures relating to effective coding requirements.
• Attend weekly meetings and present HCC Risk Adjustment Coding Department feedback, including data analysis, summary details; provide work flows and worksheets as necessary.
• Attend Coding and Billing related Trainings and Webinars and provide debriefings to management and providers.
• Other duties as assigned by the Billing Manager, Medical Director, Finance Director, or Executive Director.

Minimum Requirements

• Computer and Software Proficiency including EHR and Microsoft Office (Word/Excel/Outlook/Powerpoint) Excellent Communication Skills
• Knowledge of Payor’s Billing (including Medi-Cal and Medi-Care) rules and guidelines required
• Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (with knowledge and demonstrated understanding of CMS HCC Risk Adjustment coding and data validation requirements is preferred) Ability to work as a team player and work independently
• Reliable transportation
• Must be able to travel from facility to facility.
• This position requires 10 % travel outside the local area.
• Comply with all federal and state privacy laws and regulations including HIPAA and HITECH

Required Education/Experience and/or Licensure/Certification

• BA Degree in Healthcare preferred
• Coding Certificate from an accredited institution preferred (CCS, CPC)
• 2+ years experience in Healthcare Field as a Coder
• Technical expertise in the use and application of coding classifications such as ICD10, CPT, HCPCS and HCC Coding.
• Commitment to goals and philosophy of Northeast Community Clinic
• Valid State Identification

Physical Requirements and Working Conditions

• OSHA Category 3 Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues are not a condition of employment.
• The work is majority of the time sedentary in nature.
• The employee is regularly required to communicate, frequently required to use repetitive motions, move, remain stationary, regularly push, pull and lift up to 20 pounds and occasionally push, pull and lift up to 40 pounds.
• Must possess mobility to work in a standard office/clinic setting (in some cases both settings) and to use standard office/clinic equipment, including a computer, stamina to maintain attention to detail despite interruptions, read printed materials and use a computer, and communicate in person and over the telephone.