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UMass Memorial Health logo
UMass Memorial Health

The Relentless Pursuit of Healing

HCC Coder

Medical Billing and CodingMedical Billing and CodingFull TimeRemoteMid LevelTeam 10,001+Since 1884H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

18 days ago

Salary

$26 - $38 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

HCC Coder

UMass Memorial Health

Role Description Interprets a wide variety of clinical and diagnostic documentation to determine the opportunity for Hierarchical Condition Category (HCC) diagnosis selection and/or removal in accordance with official coding guidelines. Assigns appropriate ICD-CM (current edition) codes to outpatient office-based claims, tracks capture results, and reports clinical documentation patterns and trends. Supports all risk adjustment projects by complying with CMS requirements. Major Responsibilities: - Upon review of the medical record, performs analysis on documentation to determine the appropriate ICD-CM (current edition) codes as defined by official coding guidelines and other recognized reference materials. - Builds partnerships and works within coding teams and other organization departments critical to HCC coding. - Reviews coded records for coding quality assurance. - Verifies documentation is present to substantiate codes assigned. - Participates in the continuous coding audit and performance management program. - Maintains coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies. - Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines. - Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines. - Alerts management to any unusual or questionable situations, coding irregularities, or trends contrary to policies/procedures, so corrective measures may be taken. - Adheres to the coding and billing regulations established by the American Hospital Association (AHA), American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS). - Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation. Standard Staffing Level Responsibilities: - Complies with established departmental policies, procedures and objectives. - Attends a variety of meetings, conferences, seminars as required or directed. - Demonstrates use of Quality Improvement in daily operations. - Complies with all health and safety regulations and requirements. - Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. - Maintains regular, reliable, and predictable attendance. - Performs other similar and related duties as required or directed. Qualifications - High School diploma or equivalent. - Medical coding training and medical terminology from an accredited program. - Certification(s) as a Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P), Certified Professional Coder (CPC), or Certified Risk Adjustment Coder (CRC). Requirements - Three (3) years of HCC and/or outpatient coding experience. - Thorough knowledge of risk adjustment payment methodologies. - Thorough knowledge of ICD-CM (current edition) and CPT coding as well as CCI edits. - Thorough knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices. - Excellent interpersonal and communications skills and demonstrates professionalism. - Excellent customer service skills with the ability to communicate efficiently. - Exceptional organizational skills with attention to detail. - Ability to work independently within established guidelines. - Ability to organize and coordinate multiple functions and tasks. - Ability to problem solve, organize and prioritize workload to meet productivity benchmarks. - Ability to withstand significant level of ongoing pressure, and ability to deal with individuals with tact, discretion and diplomacy. Benefits - This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process.

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