|Employer:||PacificSource Health Plans
|Required Certifications:||CPC Certification
|Required Experience:||3 to 4 years
This position supports enterprise risk adjustment through provider engagement and education. The position will play a key role in helping the leadership team in setting strategic directions and priorities.
1. Code all assigned medical groups and facilities to validate correct ICD coding by set deadlines.
2. Maintain a coding accuracy of 95% or higher.
3. Understand, interpret and deliver Hierarchical Condition Categories (HCC) coding risk adjustment audit results to provider groups.
4. Ability to successfully perform other coding audits to validate correct coding, which include, but isn’t limited to, CPT and HCPCS coding.
5. Communicate with provider offices and their staffs, PacificSource Provider Network, and Revenue team.
6. Provide ongoing education and feedback to physicians to obtain optimal documentation to meet coding and compliance standards.
7. Assist in obtaining patient records from provider Electronic Health Record (EHR) systems.
8. Assist in obtaining remote EHR access for our chart review vendors and internal PacificSource teams.
9. Visit provider groups for on-site service calls to update office staff on administrative and claims procedures, and current coding issues.
Work Experience: Three or more years of coding experience and demonstrated knowledge of CMS rules regulations and current coding resources, including EM, CPT, ICD-10 HCPCS, fee schedule and hierarchical condition categories (HCCs).
Education, Certificates, Licenses: Bachelor’s Degree or equivalent experience in related field preferred. CPC certification required, coding experience in IPPS and OPPS preferred.