Steward Health Choice is dedicated to improving the health and well-being of the people and communities we serve.
Steward Health Choice believes in a personal approach to health care right in your community. We built our health care plan around you. Our goal is to give you quality health care, programs, and services to support you on your path to wellness.
Steward Health Choice provides exceptional customer service and culturally competent care through:
- Compassionate and responsive member services team
- Collaboration with community physicians to help members get the health care they need.
- Providing culturally competent health care, including extensive translation and interpretation services
- Health programs to help members and their families stay healthy
The Coder Specialist is to perform medical record reviews and abstract highest specificity codes effectively from medical records based on the documentation provided. This data is sent to CMS to determine accurate risk adjustment factor used to adjust payments for members’ future healthcare cost. Medical record reviews will be retrospective and must be conducted by a certified medial coder. Codes will be sequenced and assigned by documentation in the medical record which most accurately describes each documented diagnosis. The coder is responsible for ensuring diagnosis codes selected come from a face to face visit with a valid Risk Adjustable provider. The diagnosis must be coded according to International Classification of Diseases (ICD) version 9 or 10 depending on date of service for coding and reporting.
- Comprehensive understanding of Coding guidelines/rules, regulations and methodology
- Accurately and efficiently conduct medical record review/ data abstraction
- Communicate documentation inefficiencies to Clinical Correlations team
- Position is expected to be 70% remote with capability to travel into the office when required for meetings/education, or travel to visit network providers to provide trending coding education
- Must have comprehensive understanding of: the contents of a typical medical chart, medical terminology and abbreviations, ICD 9 / ICD 10 coding conventions and guidelines, what constitutes adequate substantiation of a diagnosis, and appropriate providers, documents and facilities for proper code capture
- Other duties assigned as assigned
- Complete coding quality and accuracy maintaining industry standard of 95% or better in QA audits.
- Communicate effectively and professionally with care provider offices, clinics, hospitals, other clinical facilities and Health Choice staff
- Maintain coding certification and keep up to date on industry changes
- Abide by all HIPAA and associated patient confidentiality requirements
- Analyze data and report to Management any inaccuracy of claims data to the best of coders knowledge
- Provide feedback to Clinical Correlations and Manager on education needs identified
Education / Experience / Other Requirements
- Clinical training (Medical Assistant, Registered Nurse, Licensed Practical Nurse, or Certified Nursing Assistant) preferred; College degree preferred
- Required Certification/License: Certified as CPC, CPC-I, COC, CRC, CCS, CCS-P, CPMA or RHIT
Years of Experience:
- At least three (3) years of coding experience; Clinical and HCC experience also preferred
- Knowledge of anatomy and physiology/major disease processes/pharmacology
- Knowledge of understanding etiology, pathology, signs and symptoms, diagnostic studies and treatment modalities
- Ability to work remotely from home (maintaining high speed internet as required)
- Knowledge of CMS and Commercial Health Plans
- Strong customer service skills and techniques
- Strong knowledge of HEDIS measures and their requirements
- Strong oral and written communication skills.
- Strong knowledge of risk adjustment/HCC coding
- Ability to effectively interact with staff, customers and management at all levels.
- Maintains agreed upon work schedule
- Demonstrates flexibility and willingness to embrace change
Equal Opportunity Employer Minorities/Women/Veterans/Disabled