Coder III – Medicare Risk Adjustment

Major Responsibilities:

• This role will have all responsibilities of coding assistant, coder I and II plus the following: assist with special projects as requested, assists with training other coders as requested, Monitors and responds to accounts in the charge router, charge router messages, CRMs, Compliance and Integrity review requests.
• Adhere to organizational and internal department policies and procedures to ensure efficient work processes.
• Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.
• Serves as subject matter expert in your assigned specialty and actively participate in the Coding meetings as a problem solver.
• Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate.
• Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics. Knowledgeable in researching coding related topics and issues.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
• Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
• Meets and exceeds departmental quality (95% or more) and productivity standards (100%). Achieves productivity expectations to support discharged not final billed (DNFB).
• Performs any other assigned duties since the duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.
• Assist in the production of annual edit review based on CPT, ICD and HCPCS changes as well as assist in development of edits based on publications and society updates.
• Answer and prioritize correspondence at all levels e.g., coding assistants, coders, leads, supervisors, and managers

Licensure, Registration, and/or Certification Required:

• Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)

Education Required:

• Advanced training beyond High School in Medical Coding or related field (or equivalent knowledge)

Experience Required:

• Typically requires 5 years of experience in professional coding that includes experiences in professional revenue cycle processes and health information workflows.

Knowledge, Skills & Abilities Required:

• Proficient in Microsoft Office, Word, Excel, and PowerPoint.
• Advanced knowledge and understanding of anatomy, physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology) and is able to apply these sciences to accurately assign codes to cases to include surgical cases.
• Demonstrates knowledge of National Council on Compensation Insurance, Inc (NCCI) edits, and local and national coverage decisions.
• Expert knowledge and experience in ICD-10-CM, CPT, and 3M Encoder.
• Expert knowledge and experience in ICD-10-CM and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Payment Classifications (APC).
• Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
• Expert knowledge of coding workflow and optimization of technology including how to navigate in the electronic health information record and in health information management and billing systems.
• Excellent communication and reading comprehension skills.
• Demonstrated analytical aptitude, with a high attention to detail and accuracy.
• Experienced with remote workforce operations required.
• Strong sense of ethics.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• Must be able to sit for extended periods of time.
• Must be able tocontinuously concentrate.
• Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.