Specialist III, Medical Coding Adjustment

Specialist III, Medical Coding Adjustment

Millennium Physician Group

Full Time (Monday-Friday 8AM-5PM)

Port Charlotte, FL

The Medical Coding Adjustment Specialist III is responsible for reviewing provider responses to suspected conditions and validating these responses against the entire patient medical record. This role will leverage existing EHR tools and other technologies to validate the completeness and documented clinical support of provider responses. This role aims to ensure all chronic conditions impacting the patient are addressed by the provider, present in the medical record, appropriately supported through documentation, and accurately represent the health status of the patient to the highest degree of specificity.

Responsibilities
• Acts as a preceptor to new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. Facilitates ongoing training for optimal staff functioning.
• Optimizing our billing processes, maintaining compliance, and educating providers in a visually engaging way.
• Analyze and audit findings to identify areas for improvement in provider documentation practices.
• Maintains active professional certification and complies with all educational, professional, and ethical requirements of said certification.
• Demonstrates knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions.
• Demonstrates ability to perform accurate and complete chart reviews for Hierarchical Condition Categories (HCC)/Risk Adjustment.
• Advanced knowledge and understanding of HCC/Risk Adjustment coding and documentation requirements.
• Conducts medical record reviews to evaluate documentation to ensure that diagnosis coding meets specificity requirements to support clinical indicators.
• Monitors reviews for potential risks to the organization and escalates as needed to the leadership team.
• May occasionally lead workgroups and manage project deliverables for department initiatives, audits, and provider communications.
• Provide written or oral recommendations to department leadership related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Demonstrates ability to identify and communicate trends in provider coding and documentation.
• Provide feedback to the direct supervisor of concerns and underperforming providers.
• Coordinates with provider education team to assist educational efforts.
• Possesses excellent written, verbal, communication, and attention to detail skills.
• Collaborate and work in tandem with other members of the MRA Department.
• Demonstrate excellent guest service to internal team members and patients.
• Perform other related duties as assigned.

Qualifications
• High school Diploma or GED equivalent
• 2+ years of experience, in a payer or healthcare-related field.
• 3+ years of HCC Coding experience, preferred.
• Certified Procedural Coder (CPC), CRC designation preferred.
• Certified Documentation Expert Outpatient (CDEO), OR AAPC or AHIMA Approved coding credential, or equivalent.
• Must be proficient in 10-key, Word, and Excel.
• Maintains active professional certification and adheres to all industry educational, professional, regulations, and ethical requirements.
• Perform Internal Coding Audits on Prospective and Concurrent coders/auditors and provide feedback and support.
• Organizational skills with a focus on tracking patient care and improving patient flow.
• Proven knowledge of compliance and up-to-date guidelines regarding applicable coding and documentation.
• Understands and complies with policies and procedures for confidentiality of all patient records, HIPAA, and security of systems.
• Possesses excellent attention to detail.
• Ability to maintain a consistent accuracy rate of 95% or above.
• Must be able to meet productivity standards established by Leadership.
• Ability to work independently in a fast-paced, cross-functional environment.

Benefits:

• 3 weeks PTO & 7 paid holidays
• Medical, Dental, Vision