Position
Summary
Clinical Coding Specialists are responsible for reviewing patient
medical records for Medicare Advantage enrollees, and other groups/populations
as assigned, to identify chronic conditions to be prioritized and addressed by
healthcare providers. The review process includes working with multiple
electronic health records, completing of pre-appointment reviews, completing post-appointment
reviews, and reviewing capture of chronic conditions for physician incentives. They must maintain best practices for accurate
data collection and adhere to Meritage policies and procedures.
Primary
Responsibilities
· Evaluate
the patient’s medical record and reports from the health plan to identify and
document potential chronic conditions to be addressed by healthcare providers.
· Complete
post-appointment review to assess HCC capture by providers and document
findings.
· Work
with team to ensure ICD10 codes submitted by physicians are supported by
documentation and provide feedback to inform physician education.
· Review,
assess and provide feedback to mid-level providers conducting home visits.
· Document
any additional HCC codes, when clinically indicated, on the ICE file.
· Report
any findings of noncompliance for issues not related to HCC in the Secondary
Pursuit file.
· Collaborate
with team members to research or answer any coding questions that may arise.
· Assist
in education of providers and staff regarding coding procedures and policies to
ensure compliance.
Respects patients by recognizing their rights
and maintaining confidentiality.
Promotes a team approach by encouraging communication among all members
of the care team.
Contributes
to the team’s effort and success by accomplishing delegated tasks on time and
meeting his/her daily and weekly job goals.
· Communicate
with providers regarding HCC capture via the EHR tasking system.
· Maintain
excellent customer relationships with providers, medical office staff, other
department staff and health plan representatives.
· Complete
assigned tasks daily and in a timely manner.
· Maintain
current coding credential (if applicable).
· Assist
in the training and orientation of new staff as directed.
Performs other duties and projects as
assigned that support the Care Management Team and other areas,
departments and programs within the Meritage organization.
Qualifications
· Minimum
of 1-2 years current medical background with chart review experience.
· Working
knowledge of medical terminology, anatomy and physiology, disease processes and
pharmacology.
· Able
to work effectively on an independent basis or as part of a larger work team.
· Demonstrates critical thinking skills,
sound judgement and a solid sense of accountability.
· Able
to concurrently use different electronic health record systems as needed.
· Detail
oriented and able to work as a collaborative and positive team member.
· Strong
written, verbal and listening communication skills.
· Expertise
in ICD-10-CM and CPT and RAF.
Demonstrates a professional demeanor and excellent customer services
skills.
Treats others in a respectful, kind and patient manner.
· Self-motivated
and able to ask for assistance when needed.
· Unrestricted
driver’s license and automobile insurance.
· Flexible
and adaptable to change.
Education
and Experience Requirements:
· High
School diploma or equivalent.
· CPC
certification required. CRC certification preferred.
· Medical
office/chart review experience.
· One
year of previous recent procedural/diagnosis coding, or equivalent work
experience.
· Two
years of customer service experience in a healthcare related setting.
· Working
knowledge in Risk Adjustment or HCC coding.
· Experience
with Accountable Care Organization (ACO) or Direct Contracting Entity (DCE)