POSITION DESCRIPTION
The Project Coder reviews clinical documentation and assings the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment payment methodology. He or she also analyses and performs reports and other administratives tasks related to vendors and department’s projects.
RESPONSABILITIES
1. Supports team on second review audits to ensure quality in vendor’s coding performance
2. Analyse data base on diagnosis, medical services, codes, RAF or HCC from reports and other applications.
3. Review medical documents such as surgical reports, medical visits, Annual Health Assessments forms in order to assign correct diagnosis codes according to guidelines
4. Supports team on CMS (Centers of Medicare and Medicaid Services) annually in the National RADV (Risk Adjustment Data Validation) audits samples.
5. Coordinate and manage data from special projects such as education, QuantaFlo, AHA and CAP
6. Prepares and submits to the supervisor a monthly report of activities performed.
7. Participates in training to maintain updated with CMS regulations
8. Performs other duties relevant to the position.
EDUCATION AND EXPERIENCE
Educational requirements:
Bachelor of science in biology, nursing, business adminatration or related to the health industry from an accredited school.
Professional certifications and experiece
Certificated coder with at least 1 year of experience in clinical work, medical coding, medical billing, care management, utilization or orther medical record reviewing. Recognized certifications by the American Academy of Professional Coders (AAPC) or American Health Information Management (AHIMA). These are: CRC, CPC, CIC, COC, CPC-P, CPMA, CDEO, CCS, CCS-P, CDIP, RHIA or RHIT.
Or registered nurse (RN) in PR with an active licence and at least 1 year of medical coding, medical billing, medical record reviewing, drug or provider representative experience.
Or at least 2 years of experience in clinical work, medical coding, medical billing, care management, utilization or orther medical record reviewing.
SKILLS AND ABILITIES
1. Must have ability to work as a team player with excellent communication Skills.
2. Must solve resource issue in a creative, positive manner.
3. Must possess the ability to make independent decisions when circumstances warrant such action.
4. Must be able to read medical charts
5. Stay updated on CMS rules and guidelines.
6. Must be able to use a laptop, Word, Excel and Outlook programs.
7. Requires sitting and standing associated with a normal office environment; mobility to do audits at physicians sites.
8. Perform tasks requiring independent knowledge and judgment in addition to instructions and procedures provided.
9. Must be able to function with frequent interruptions, accept change and able to prioritize activities when faced with competing demands.
GENERAL SKILLS
? Knowledge and interpretation of the systems of standard classification (CPT, ICD 9, ICD-10 and HCPCS)
? Knowledge and interpretation of the prospective systems of payment of Medicare Advantage
? Knowledge of plan of treatments, diagnosis and pathophysiology
? Knowledge of the National and Local Rules of Correct Coding according to defined by CMS.
? Computer systems knowledge (Internet, Microsoft Office)
? Skill in enabling personnel
? Capacity of concentration and analysis
? Ability to work under pressure
? Organization/Structure
? Responsibility
? Decision making capability in its area of expertise
? Didactic capacity
LANGUAGE SKILLS
Bilingual. Ability to read, analyze, and interpret general business periodicals, operating and maintenance instructions, procedure manuals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
MATHEMATICAL SKILLS
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
REASONING ABILITY
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
PHYSICAL AND MENTAL DEMANDS
Requires sitting and standing associated with normal office environment. Regularly talks and hears. This position requires that weight be lifted or force be exerted up to 25 pounds.
ENVIRONMENTAL AND WORKING CONDITIONS
Normal office environment and able to work remotly. The noise is typically moderate. Evening or weekend work, as necessary.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
Job Type: Full-time
Experience:
Medical Coding: 1 year (Required)
Benefits:
Health insurance
Dental insurance
Vision insurance
Retirement plan
Paid time off
Work from home
Parental leave
Tuition reimbursement
Other
This Job Is Ideal for Someone Who Is:
Dependable -- more reliable than spontaneous
People-oriented -- enjoys interacting with people and working on group projects
Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction
Detail-oriented -- would rather focus on the details of work than the bigger picture
Achievement-oriented -- enjoys taking on challenges, even if they might fail
Autonomous/Independent -- enjoys working with little direction
Innovative -- prefers working in unconventional ways or on tasks that require creativity
High stress tolerance -- thrives in a high-pressure environment
Schedule:
Monday to Friday
Day shift
8 hour shift
Other
Company's Facebook page:
https://www.facebook.com/MMMyPMC/?_tn=%2Cd%2CP-R&eid=ARDaqdb48CaSo250ggUEeYp1-191-rT-bgtfy9m5M2qjZYSgeJtvHzs8zq8pc5lGcEoVRk3D6E4aKZD
Benefit Conditions:
Waiting period may apply
Only full-time employees eligible
