Remote - Risk Coder/HCC Coder
Steward Health Care Network is searching for HCC Coders for a position located in Needham, MA, with some travel to physician practices/hospitals across the Network. This role requires at least 1 year of HCC Coding, and current Medical Coding Certification .
Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
Identify areas of potential compliance risk across the Network.
Review medical records retroactively and proactively including patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether:
The diagnosis codes are supported by the documentation and ensure with ICD-9-CM Guidelines for Coding and Reporting.
The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe.
Any diagnosis code is unsubstantiated by the record and should be eliminated.
Review for clinical indicators and query providers to capture the severity of illness of the patient.
Interacts with providers regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
Demonstrate the ability to quickly identify low risk scores, incorrect coding and compliance trends; to analyze and investigate suspected problems with resolve; and to forward problems to the attention of the Performance Management Team
Must have CPC, CPC-H, CCS-P, CCS, RHIA, or RHIT
Must have at least 6 months of HCC / MRA experience
Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements.
Ability to use technology effectively; HCC coder will be using a dashboard tool to analyze and generate reports.
Job Status: Full Time
Job Reference #: 3285