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Clinical Coding Specialist Job in Novato, California

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Job Title: Clinical Coding Specialist

Employer:Meritage Medical Network
Job Location:Remote
Required Certifications:CPC
Preferred Certifications:CPC or CRC
Required Experience:1 to 2 years
Preferred Experience:1 to 2 years
Location:4 Hamilton Landing Suite 100 Novato 94949, CA, US
* Note: This listing is for a remote position
Date Posted:3/8/2022

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.



·       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)



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