The Medical Coding Professional extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Medical Coding Professional confirms appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Consultative Coder
The Consultative Coder provides medical coding expertise to support clinical staff (Physicians and Advanced Practice Providers) to ensure the documentation within medical records supports diagnostic and procedural coding.
Relationship/Concierge Services:
Cultivate relationships with clinicians (Physicians and Advanced Practice Providers) to serve as the single point of contact for questions and issues relating to documentation and coding.
Based on one-on-one engagement with clinicians, identify documentation improvement areas and partner with clinical and coding education to deliver education related to improvement opportunities
Analyze trends, triage, and answer questions in real-time.
Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.
Post-Visit/Offshore Coding Collaboration:
Perform Quality Assurance on post-visit reviews. (Frequency and sampling methodology to be determined)
Review the encounter for potential missed opportunities.
Address nonbillable services at the provider level.
Address documentation deficiencies resulting in not billable services in a timely manner (missing chief complaint, missing time for audio only visits, and missing telehealth platform)
Serve as liaison to provide timely updates on documentation requirements and process changes.
Mergers and Acquisitions:
Responsible for the special handling of Mergers & Acquisitions:
Perform Problem list cleanup (as outlined by compliance)
Conduct PCO Process training including but not limited to reporting for open notes and addendums, and gap attestation process and performance expectations.
Train acquired providers on PCO documentation requirements and processes.
Other Duties:
Lead Special Projects within the Division/Markets
As requested by Market leaders, perform the following duties:
Summarize and analyze AWV completion rates ( what criteria is needed to complete AWV)
Analyze EDAPS; report the variances between datahub and eCW.
Conduct Chart reviews to identify educational opportunities.
Perform individual chart research as requested.
Collaborate with HEDIS leaders and champions to identify HEDIS gaps and deficiencies.
Participate in Payer calls/chart reviews.
Compile payer findings and assist with research.
Participate in payor meetings/discussions to ensure accurate data submission.
Use your skills to make an impact
Required Qualifications:
A minimum of three years Medical Coding experience or similar (including IPA and Offshore coding management)RHIA, RHIT, CCS, or CPC CertificationAbility to travel both locally and overnight.Preferred Qualifications:
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPointAbility to communicate effectively and sensitively with clinicians and team members in stressful situations.Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization.Ability to work in a rapidly changing, matrixed environment.Has a positive, collaborative mindset to foster partnership within and the Coding, Audit, and Education department, the PCO, and HumanaPassionate about contributing to an organization focused on continuous improvement.Proficient verbal and written communication skillsPublic speaking / group presentation skillsAdditional Information
100% remote role Standard working hours required; 8:00 am - 5:00 pm; Central or Eastern Time ZonesAnticipated location and overnight travel is