risk adjustment coder

Baptist Health System KY & IN

<div>Summary
Job Description:
Baptist Health Medical Group is looking for an Ambulatory CDI Specialist to join our team! This is a remote work position that requires residency in KY or IN
<div><div><div><div><div><div><div><div><div>The BHMG Ambulatory CDI Specialist I is responsible for the evaluation of documentation utilizing their coding and clinical expertise to ensure specificity of coding and coding accuracy. They identify HCC diagnosis codes, ensure documentation accurately reflects the medical necessity and acuity of the patients. They provide guidance/education to the providers, medical assistants, practice managers and ancillary staff on clinical documentation best practices. Position requires a self-motivated, flexible, confident presenter that is able to travel and work remotely as well as attend internal meetings.
Minimum Education, Training, and Experience Required
<ul><li>2 years&rsquo; professional medical group coding experience
</li><li>Experience with:
<ul><li>ICD-10-CM coding principles and procedures,
</li><li>HCPCS, CPT, CPT II and modifier coding,
</li><li>CMS HCC, HHS HCC, Rx HCC coding and risk adjustment assignment as it relates to provider documentation,
</li><li>Knowledge of Microsoft Office (Outlook, PowerPoint, Excel)
</li></ul></li></ul><ul><li>Preferred Experience
<ul><li>HCC (CMS, HHS, Rx HCC) coding and risk adjustment assignment as it relates to provider documentation,
</li><li>Proficient experience with Epic and/or other major EMR vendor software, and
</li><li>Presenting education to coders, providers and/or other caregivers.
</li><li>Clinical experience a plus
</li></ul></li></ul>Certification/Licenses:
<ul><li>Active Certification Required:
<ul><li>Certified Professional Coder (CPC)
certification or Certified Coding Specialist-Physician based (CCS-P) or equivalent
certification from AAPC, AHIMA or other
acceptable professional organization.
</li></ul></li><li>A minimum of one additional advanced certification, required within one year of hire.
<ul><li>CRC = Certified Risk Adjustment Coder (certification)
</li></ul></li></ul></div></div></div></div></div></div></div></div></div>Work Experience
Education
<h3 class="jobSectionHeader">If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!
</h3><h3 class="jobSectionHeader">Baptist Health is an Equal Employment Opportunity employer.</h3></div>

BHMG Ambulatory CDI Specialist

Think Whole Person Healthcare Aksarben

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 Back To Openings
 
 
 Clinical Coder
 
 
 
 Department:
 
 Billing
 
 Location:
 
 Omaha, NE
 
 
 START YOUR APPLICATION
 
 
 
 Core Value Commitment
 
 
 
 In common mission, our teams work together with our patients at the center. We strive to continuously improve. We value one another&rsquo;s diversity of talent, experience, and perspective. We each contribute to something bigger than ourselves while promoting integrity, belonging, and collaboration.
 
 
 
 Job Summary
 
 
 
 The Clinical Coder is responsible for performing and ensuring the accurate and timely completion of patient record coding. This role serves as the educator, subject matter expert, and liaison for all coding matters. The Clinical Coder investigates and resolves coding related issues and leads the process improvement efforts to minimize inefficiencies, enhancing the patient experience.
 
 
 
 Essential Job Functions
 
 
 
 <ul>
 <li>
 Perform coding activities to assure accurate completion of coding for all patient records including review of each charge submission for accuracy, addition of appropriate modifiers, scrubbing of claims, preparation for insurance submission, and closing of clean batches.
 </li>
 <li>
 Analyze medical records for complete documentation and directly communicate with providers for clarification on any documentation that is incomplete or inaccurate.
 </li>
 <li>
 Remain current on all coding related regulations, standards, guidelines, industry trends, and Medicare announcements.
 </li>
 <li>
 Educate physicians, clinicians, and other healthcare staff on changes to coding policies, standards, regulations and advocate for proper documentation practices.
 </li>
 <li>
 Investigate and problem solve all contractual obligation (CO) denials received from the billing staff on charges reviewed and coded. Inform billing staff of the proper correction needed to reprocess the denied claims.
 </li>
 <li>
 Investigate and resolve all patient requests relating to the billing and coding of patient visits and subsequent bill received.
 </li>
 <li>
 Improve patient experience by being inquisitive, responsive, innovative, and flexible.
 
 
 </li>
 </ul>
 
 Knowledge, Skills &amp; Abilities
 
 
 
 <ul>
 <li>
 Knowledge of medical terminology, ICD-10, and CPT codes.
 </li>
 <li>
 Knowledge of Evaluation &amp; Management coding.
 </li>
 <li>
 Knowledge of regulatory requirements related to coding.
 </li>
 <li>
 Skill in using a computer and a variety of software, including Electronics Health Records (EHR) software, Word, Excel, Access, and Outlook.
 </li>
 <li>
 Skill in communicating in a professional manner, both verbally and in writing.
 </li>
 <li>
 Ability to work independently and in a team environment.
 </li>
 <li>
 Ability to act as a good representative of the company.
 </li>
 <li>
 Ability to work flexible hours.
 
 
 </li>
 </ul>
 
 Education &amp; Experience
 
 
 
 Associate&rsquo;s Degree in Medical Coding or equivalent experience required. Certified Procedure Coder (CPC) through National American Academy of Professional Coders (AAPC). Local involvement in AAPC and 2+ years of coding experience in a primary care setting preferred. Certified Risk Adjustment Coder (CRC) and prior medical coding audit experience preferred.
 
 
 
 Working Conditions And Physical Effort
 
 
 
 This role operates in a healthcare setting. This position requires frequent sitting and computer work and allows employee to vary physical position or activity for comfort.
 
 
 <ul>
 <li>
 Must be able to:
 </li>
 <ul>
 <li>
 Stand 15% or longer of an 8-hour workday.
 </li>
 <li>
 Walk 5% of an 8-hour workday.
 </li>
 <li>
 Sit 80% of an 8-hour workday.
 </li>
 </ul>
 <li>
 Requires ability to lift up to 10 pounds occasionally.
 </li>
 <li>
 Requires employee to: bend, squat, kneel and reach above shoulder level occasionally and twist occasionally.
 </li>
 <li>
 Requires repetitive use of hands for: simple grasping, fine manipulation, computer use
 </li>
 <li>
 Requires all sensory skills (speech, vision, smell, touch, and hearing) corrected to near normal range.
 
 </li>
 </ul>
 
 NOTE:
 
 The information above is a reflection of the general nature of job duties. From time to time, additional duties may be assigned.
 
 
 START YOUR APPLICATION
 
 
 
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Clinical Coder

Texas Children's Hospital

<div>We&rsquo;re searching for a Coding Quality Assurance Specialist I - someone who works well in a fast-paced setting. In this position, you will assign and audit the accuracy of the ICD-10-CM and CPT codes to ambulatory, emergency center, observation, and day surgery records for purposes of billing, research, and providing information to government and regulatory agencies. The position also ascertains the accuracy of the physicians' E/M and procedure coding, completes the auditing reporting tool, and provides this feedback to the education team and/or provider.
Think you&rsquo;ve got what it takes?
Job Duties &amp; Responsibilities
Assigns ICD-10-CM and CPT codes.
Reviews documentation in records to appropriately assign ICD-10-CM, PCS, and CPT codes.
Communicates with and provides feedback to the education team and/or provider.
Utilizes the encoder or coding books to correctly assign all appropriate ICD-10-CM, ICD-10-PCS, and CPT codes for diagnosis and procedures.
Sequences diagnosis and procedures to generate appropriate DRGs for billing in accordance with the Coding Guidelines based on the type of coding.
Queries physicians to obtain clarification or missing elements in the record preventing correct coding.
Utilizes available resources for assignment of codes as necessary (e.g., Diagnostic Imaging system, Lab system, Emergency Center system, Cardiac Cath system, Epic, and coding reference books).
Inputs codes into the Epic computer system utilizing the Encoder.
Completes abstracts if appropriate.
Identifies problem accounts.
Assists in correction of problem accounts.
Participates in education and maintains certification.
Maintains concurrent coding for all records.
Skills &amp; Requirements
Required H.S. Diploma or GED
Required Certifications
LCCA - Certified Coding Associate
CCS - Cert-Cert Coding Specialist
CCS-P - Cert-CCS-P Physician Based
CIPC - Certified Inpatient Coder
COC - Certified Outpatient Coder
COC-A - Cert Outpat Coder - Apprentice
CPC - Cert-Cert Professional Coder
CPC-A - Cert Prof Coder - Apprentice
CRC - Cert Risk Adjustment Coder
RHIA - Cert-Reg Health Infm. Admins
RHIT - Cert-Reg Health Infm. TECH
Required 1 years&rsquo; experience as a coder</div>

Coding Quality Assur Spec I

Blue Cross Blue Shield of Michigan

<div>Department Preferences
<ul><li>A completed Coding Certification preferred.
</li><li>Associate's degree in medical coding, health information technology or another closely related field preferred.
</li><li>Working knowledge and proficiency in medical terminology, anatomy and physiology.
</li><li>Be familiar and proficient in basic and advanced ICD-10-CM, CPT and HCPCS coding, Medicare guidelines and compliance.
</li>Experience and knowledge of HCC Coding and Risk Adjustment experience a plus. 
<li>
</li></ul>Responsible for assisting and supporting management in the evaluation, recommendation, establishment, implementation and analysis of new and improved production workflows, work processes for systems, reporting and new products/programs to improve customer service levels and overall quality.
<ul><li>Support the development, coordination, and implementation of projects to enhance the overall efficiency of operational procedures, methods, controls, and performance.
</li><li>Compile and analyze operational data to identify and resolve business problems.
</li><li>Utilize and maintain available reporting systems. Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process.
</li><li>Provide leadership team with status updates on projects and issues.
</li><li>Communicate and recommend policy changes to achieve project objectives. Assist in documenting departmental procedures.
</li><li>Create and present reports and presentations to display operational data and propose business changes.
</li><li>Provide support to both internal departments and external entities by answering questions, supplying information and training.
</li><li>Participate on special projects or workgroups as assigned.
</li></ul>&quot; Qualifications &quot;
<ul><li>Bachelor's Degree in a related field is preferred.
</li><li>Two (2) years of experience in a related field is required.
</li><li>Effective verbal, written communication and interpersonal skills.
</li><li>Ability to work independently or in a team environment and interact with all levels of the organization.
</li><li>Effective analytical and problem-solving skills to identify, evaluate, recommend and implement changes to processes or procedures to address problems and improve departmental effectiveness.
</li><li>Organizational skills and ability to prioritize; must be able to coordinate multiple activities with varying timelines.
</li><li>Proficient in Microsoft Office suites.
</li><li>Ability to develop and maintain effective working relationships.
</li></ul><div>All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.</div></div>

Analyst (Medical Coding)-104640 Marketplace Ops

Cooper Family Medical

Overview Join our healthcare team as a Certified Professional Coder (CPC), where your expertise in medical coding and billing will play a vital role in ensuring accurate and efficient processing of medical records. As a CPC, you will be responsible for translating healthcare services into standardized codes, facilitating seamless communication between healthcare providers, insurance companies, and patients. Your attention to detail and thorough understanding of medical terminology and coding systems will directly impact the quality of patient care and reimbursement processes. This role offers a great opportunity to apply your coding skills in a fast-paced environment dedicated to excellence .Duties<ul><li>Commercial claims processing</li><li>Reviewing charts before sending out and then working payments and denials post-processing.</li><li>Records review to maximize the quality of coding</li><li>Communicate with the providers when needed for missing, or non-specific information that is present in the health record</li><li>Assure compliance with coding rules and regulations according to regulatory agencies for Center for Medicare Services (CMS)</li><li>Performs accurate and timely charge entries into billing software</li><li>Stays up to date with coding changes</li><li>Informs management of trends identified through the review and validation process</li><li>Ensure clean claim submissions</li><li>Work with insurance companies for reports, denials, and re-submission of claims</li><li>Identify and troubleshoot billing, coding, and payer issues</li><li>Attends office meetings as necessary to provide information relating to coding and compliance</li><li>Performing medical coding of encounters and reviewing medical codes for adherence to risk adjustment models</li><li>Daily audits of medical record data pre and post patient visit to ensure accuracy will be performed</li><li>Make recommendations according to regulations and your employer&rsquo;s operational policies</li><li>Report the results of an audit to the relevant supervisor or coding service provider</li><li>Have overall proficiency with revenue cycle workflows</li><li>It is your job to ensure compliance with rules related to patient privacy and electronic medical record keeping</li><li>Always demonstrate service excellence</li></ul>Qualifications<ul><li>Certified Professional Coder (CPC) credential from the American Academy of Professional Coders (AAPC) or equivalent certification</li><li>Proven experience in medical coding, including CPT coding, ICD-9/ICD-10 coding, DRG assignment, and medical records review</li><li>Strong knowledge of medical terminology, anatomy, physiology, and healthcare documentation standards</li><li>Familiarity with EMR/EHR systems used for medical record management and coding purposes</li><li>Experience with medical billing, collections, and insurance claim processes</li><li>Excellent attention to detail with the ability to interpret complex clinical documentation accurately</li><li>Effective communication skills for collaborating with healthcare providers and insurance representatives</li></ul>Join us to leverage your coding expertise in a role that is essential to delivering high-quality healthcare services.Benefits:<ul><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Work Location: In person

Certified Professional Coder (CPC)

RestorixHealth

PRIMARY RESPONSIBILITIES: 
<ul>
<li>Onboarding new/additional coders to RestorixHealth Coding Team, including:</li>
<li>Participation in the interview process with VP, Revenue Integrity.</li>
<li>Administer coding proficiency assessments for potential coders (applicants).</li>
<li>Training/review all needed systems for newly hired certified coders.</li>
<li>Monitor proficiency and accuracy of newly hired certified coders for 30 days.</li>
<li>Monitor coder productivity and work with Coding staff to ensure that all charts are coded timely and correctly.</li>
<li>Establish back up plan/cross coverage (to address time off, unexpected team absences, etc.) to ensure that timely coding is maintained.</li>
<li>Assist Coding staff as needed to escalate concerns (to senior staff as needed) regarding incomplete charts that cannot be coded.</li>
<li>Monitor center coding volume and coder workload to ensure adequate workload distribution and to ensure that all completed charts are coded in a timely manner.</li>
<li>Compile monthly coder labor report for reclassification by finance team.</li>
<li>Provide monthly coder productivity report to VP, Revenue Integrity (report to include average number of charts coded per hour, lag time between, “Ready to Code” and “Coding Complete” and “Coding Inquiry Follow-Up Complete” and “Coding Complete” by the 10th of the following month.</li>
<li>Comply and prepare other ad hoc reports as needed or requested by VP of Revenue Integrity.</li>
<li>Complete annual staff coding performance evaluations with VP of Revenue Integrity.</li>
<li>Serves as primary resource and support for coding staff.</li>
<li>Establish coding proficiency/accuracy/competency requirements.</li>
<li>Performs coding proficiency/accuracy reviews for each staff coder, to be conducted no less than once per year, preferably twice per year.</li>
<li>Provide in collaboration with VP of Revenue Integrity and Senior Auditor, annual coding updates for coding staff and senior leadership.</li>
<li>Code for assigned centers as needed to support overall productivity, staff shortages and overall team obligations.</li>
<li>Work with leadership to coordinate and present as needed, coding, billing and documentation education.</li>
<li>Monitors, reviews and approves timely submission of coders time sheets.</li>
<li>In collaboration with VP of Revenue Integrity, reviews and approves coders requests for PTO.</li>
<li>Oversee internal Audit processes performed by Coders and Auditors.</li>
<li>Administer and uphold all the Company’s values and policies and procedures.</li>
<li>Continuously work towards the Company’s goal and vision.</li>
<li>Performs other duties as assigned.</li>
</ul>
ADDITONAL RESPONSIBILITIES: 
<ul>
<li>Assist Coders, Revenue Cycle Representatives (RCR), Revenue Cycle Directors (RCD) and other internal staff engaged with responsibilities related to or responsible for coding of charts for specific/previously identified hospitals/centers with POR contractual arrangements.</li>
<li>Assist Coders, Revenue Cycle Representatives (RCR), Revenue Cycle Directors (RCD) and other internal staff engaged with internal and/or external chart audits and reviews to ensure.</li>
<li>Assist Revenue Cycle Managers, documentation supports reported of billed services. Regional Directors, Program Directors, VP of Revenue Integrity and VP of Revenue Cycle as needed with follow up education and support as needed and/or directed by supervisor.</li>
<li>Subscribe to relevant and appropriate trade industry related list services and updates, including but not limited to:</li>
<li>AAPC</li>
<li>Medicare MAC’s</li>
<li>Commercial Payers</li>
</ul>
EDUCATION AND TECHNICAL SKILLS: 
<ul>
<li>Required CPC certification from APPC, additional certifications may include these and others as awarded by AAPC:</li>
<li>CPB (Certified Professional Biller)</li>
<li>CRC (Certified Risk Adjustment Coder)</li>
<li>CPC-I (Certified Coding Instructor)</li>
<li>Maintain Coding Certification(s) as required by AAPC.</li>
<li>Proficient and highly knowledgeable of current coding and billing guidelines:</li>
<li>ICD-10</li>
<li>CPT</li>
<li>HCPCS</li>
<li>Knowledge of current and appropriate use of Modifiers.</li>
<li>General knowledge of HIPAA related guidelines specific to coding and billing.</li>
<li>General knowledge of current claims filing principles and guidelines.</li>
<li>Minimum 5 years’ experience with direct coding responsibilities.</li>
<li>Minimum 5 years’ experience claim filing and billing knowledge.</li>
</ul>
•
 
ADDITIONAL ELIGIBILITY QUALIFICATIONS/COMPETENCIES: 
<ul>
<li>Ability to promote subordinate staff professional growth and expertise.</li>
<li>Demonstrated ability to work with all levels of staff effectively.</li>
<li>Excellent organizational and analytical skills required.</li>
<li>Strong, effective interpersonal and written communication skills required.</li>
<li>Ability to multi-task and prioritize.</li>
<li>Strong follow up skills are required.</li>
<li>Ability to effectively interact with all levels of an organization.</li>
<li>Diversity – Demonstrates knowledge of Equal Employment Opportunity (EEO) policy; shows respect and sensitivity for cultural differences; educates others on the value of diversity; promotes and harassment-free environment; builds a diverse workforce.</li>
<li>Ethics – Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and principles; upholds organizational values.</li>
</ul>
PHYSICAL REQUIREMENTS: 
This position requires periods of time in which sitting, standing, use of hand and foot motion, vision, hearing, summarizing, focusing with frequent interruptions along with other physical, sensory and cognitive sensory functions are required.
 
Note: The above is intended to describe the general content of and requirements for the performance of this job. It is not construed as an exhaustive statement of duties, responsibilities or requirements and may change at any time.
 
The Company is an Equal Opportunity Employer (EEO). All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, disability, or protected veteran status.

Coding Manager- Wound Care- Full Time

Tidelands Health

<div>
 Employee Type:
 
 
 Regular
 
 
 Work Shift:
 
 
 Day - 8 hour shift (United States of America)
 
 
 
 Join Team Tidelands and help people live better lives through better health!
 
 
 
 
 Clinical Documentation Improvement Specialist (RN) (3419)
 
 
 
 Are you passionate about quality and committed to excellence? Consider joining our Tidelands Health team. As our region's largest health care provider, we are also one of our area's largest employers. More than 2,500 team members at more than 70 Tidelands Health locations bring our healing mission to life each day.
 
 
 
 A Brief Overview
 
 
 
 The Clinical Documentation Improvement Specialist (RN) is a hybrid role that combines the expertise of clinical documentation improvement (CDI) and outpatient Hierarchical Condition Category (HCC) coding. This position will report to the Outpatient CDI Program Manager. This position focuses on improving the accuracy, quality, and completeness of clinical documentation in outpatient medical records while ensuring compliance with coding guidelines. The specialist will work collaboratively with providers, coding teams, and other healthcare professionals to facilitate accurate coding, improve risk capture, and optimize reimbursement while reflecting the true severity of illness and care provided.
 
 
 
 Education Qualifications
 
 
 
 <ul>
 <li>
 BSN and a minimum of five years clinical nursing experience Required
 
 
 </li>
 </ul>
 
 Experience Qualifications
 
 
 
 <ul>
 <li>
 At least 3 or more years' experience either in the clinical field (RN), CDI field, or coding field Required
 </li>
 <li>
 Experience in an outpatient or acute care setting Required
 </li>
 <li>
 1 or more years' experience in HCC/Risk Adjustment Preferred
 </li>
 <li>
 Minimum of 3 years of experience in clinical documentation improvement, outpatient Hierarchical Condition Category (HCC), or a combination of both Preferred
 
 
 </li>
 </ul>
 
 Skills And Abilities
 
 
 
 <ul>
 <li>
 Strong clinical experience and critical thinking skills required
 </li>
 <li>
 Extensive knowledge of patient care, and knowledge of clinical measurement, tools, and clinical outcomes
 </li>
 <li>
 Ability to establish cooperative, working relationships with diverse groups and individuals, medical staff and other healthcare disciplines
 </li>
 <li>
 Ability to work independently, be resourceful, and possess strong organizational skills
 </li>
 <li>
 Ability to communicate effectively with physicians and other clinical staff; be courteous and professional
 
 
 </li>
 </ul>
 
 Licenses and Certifications
 
 
 
 <ul>
 <li>
 Registered Nurse - South Carolina Department of Labor, Licensing and Regulation Required
 </li>
 <li>
 Certified Professional Coder - American Academy of Professional Coders within 1 Year Required or
 </li>
 <li>
 Certified Coding Specialist - American Health Information Management Association within 1 Year Required or
 </li>
 <li>
 Certified Clinical Documentation Specialist - Association of Clinical Documentation Integrity Specialist within 1 Year Required
 
 
 </li>
 </ul>
 
 Physical Demand
 
 
 
 Light Physical Demand
 
 
 The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a contract for employment nor a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform tasks other than those specifically presented in this description.
 
 
 Tidelands Health is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
 
 
 Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.
</div>

Outpatient CDI Specialist (RN)

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