Medical Coder Job in PIttsburgh, Pennsylvania

Position Summary:

Under the direction of the Coding Manager, the HCC Coder is responsible for CPT and ICD-10 coding to ensure accuracy and maximum reimbursement.  This individual will interface with provider partners to successfully monitor and implement an HCC coding strategy and provide coding expertise.

Essential Job Functions:

• Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.
• Review medical record information to identify all appropriate coding based on CMS HCC categories.
• Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
• Support and participate in process and quality improvement initiatives.
• Schedule and perform training activities and maintain records of training.
• Monitor the implementation of Corrective Action Plans as needed, and track implementation as it relates to HCC activities and high risk patients, especially in insuring that those patients have appropriate medical record problem lists and corresponding risk score.
• Coordinate CMS Data Validation activities, including record selection, tracking and submission.
• Maintain a comprehensive tracking and management tool to track all HCC activities and insure that all tasks are completed in a timely manner.
• Correlate activities, processes and HCC results/ metrics to evaluate outcomes.