Certified Medical Coder Specialist

Biofourmis is a rapidly growing, global digital health company filled with committed, passionate professionals who care about augmenting personalized care and empowering people with complex chronic conditions to live better and healthier lives. We are pioneering an entirely new category of medicine by developing clinically validated, software-based therapeutics to provide improved outcomes for patients, smarter engagement & tracking tools for clinicians, and cost-effective solutions for payers. We are collectively devoted to a single-minded idea: powering personally predictive care.

Our dynamic growth has been marked by doubled headcount in the last 12 months via both expansion & acquisition, yielding a global footprint with offices in Boston, Singapore, Bangalore, and Zurich. We are backed by prominent international venture capital investment & have cultivated relationships with worldwide healthcare stakeholders over the last 5 years. Our talented team features numerous PhD’s in Data Science and Biostatistics, over 80 patents, prolific scientific publications, world-class systems, developers & engineers, and leaders in the clinical operations space.

Job Summary:

The Certified Medical Coding Specialist will evaluate medical records and charge tickets to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual - Clinical Modification (ICD-10-CM), and the American Medical Associations Current Procedural Terminology Manual (CPT). The Specialist will also provide technical guidance and training on medical coding to physicians and staff.

Job Responsibilities:

• Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Researches and analyzes data needs for reimbursement.
• On-site review and analysis pf provider documentation with an eye towards compliance with CMS rules and regulations to capture risk adjusting (HCC) diagnoses.
• Analyzes medical records and identifies documentation deficiencies.
• Serves as resource and subject matter expert to other coding staff.
• Reviews and verifies documentation supports diagnoses, procedures, and treatment results.
• Identifies diagnostic and procedural information.
• Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.
• Follows coding conventions. Serves as coding consultant to care providers.
• Identifies discrepancies, potential quality of care, and billing issues.
• Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.
• Identifies reportable elements, complications, and other procedures.
• Serves as resource and subject matter expert to other coding staff.
• Provides ongoing training to staff as needed.
• Handles special projects as requested.

Required Skills/Abilities:

• Strong knowledge of ICD-10-CM and CPT coding guidelines; medical terminology; anatomy and physiology; state and federal Medicare reimbursement guidelines; English grammar and usage.
• Experience in Coding Specialty- HCC Coding
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to read and interpret medical procedures and terminology.
• Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff.
• Knowledge of HIPPA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation.

Education and Experience:

• Possession of an Accredited Record Technicians certification (ART) or Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association; or
• 3-4 years of experience in medical record coding specializing in HCC Coding, or the;
• Equivalent combination of experience, education, and training that would provide the required knowledge and abilities.