Find The RightJob.

Coder Level 3

The Coder level III is responsible for reviewing medical records and identifying, collecting, assessing, monitoring and documenting claims and encounter information as it pertains to Medicare Risk Adjustment. You implement ongoing quality improvement activities to assure the Medicare Risk score meets all requirements and act as a consulting MRA advisor to the practices you support. You review practices for both CMS and Commercial ACO’s for quality compliance.

Responsibilities:

Performs on-site and remote clinical validation audits and interpretation of medical documentation to capture all Medicare Risk codes in coordination with the physician.
Provides guidance and consultation to practice team members to drive improved MRA coding proficiency over time
Verifies and ensures the accuracy, completeness, specificity, and appropriate coding based on CMS HCC categories
Analyzes and translates medical and clinical diagnoses, procedures, and illnesses into Medicare Risk codes
Reviews medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries
Represent the Quality department with tracking open gaps to ensure HEDIS standards are meet as follow but not limited to: Part-D & Medication Adherence, Part-C & Preventive Care measures, Patient Experience and Audit Process
Engage with practice management team members on applying correct steps into daily process including and no limited to module software on an ongoing basis
Support affiliate medical centers to increase uniformity on the generalization on daily process where Quality data is collected
Participates in audits and analyzes data to identify trends and improvement opportunities
Performs ongoing analysis of medical charts to ensure all codes are reported timely and properly to CMS
Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to Medicare coding and documentation guidelines
Facilitates education and/or educates providers and office staff on proper CMS Risk Adjustment coding, billing, pay for performance measurements and medical record review criteria
Communicates with co-workers, management, and practice staff regarding documentation, claim submission and reimbursement issues
Provides support and compliance through effective communication and training/education
Participates in departmental and organizational quality management activities
Cooperates with other personnel to achieve department objectives and maintain good employee relations, and interdepartmental objectives
Attends departmental meetings as required
Effectively manage special projects and other tasks as assigned
Document and trend findings in identified database
Any other duties or responsibilities assigned