Medicare Risk Adjustment Coding Analyst
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Portland, ME 04104
Responsible for auditing MPHC health centers’ medical record documentation to ensure use of accurate medical coding of all professional, inpatient and outpatient services, procedures, diagnoses and conditions in support of accurate Medicare risk adjustment revenue. Classification systems used include ICD-9/10-CM, CPT, as well as other specialty systems as required by diagnostic category. This work is performed utilizing the rules, regulations and coding conventions of the American Hospital Association (Coding Clinic), ICD9/10-CM, Centers for Medicare and Medicaid Services (CMS), and organizational/institutional coding guidelines.
Accurately and efficiently reviews medical charts and assigns the correct diagnosis (ICD-9/10 CM), procedure (CPT), and supply (HCPCS Level II) code for a wide variety of clinical cases and services.
Effectively communicates with physicians in order to clarify diagnoses/procedures and sequencing of diagnoses.
Utilizes specialized coding knowledge and auditing skills to achieve established coding quantity and quality standards.
Assesses medical coding practices and suggests areas of improvement for follow up physician training and communication.
Collaborates with Part D, Star Rating and Health Management staff to support Star Rating and disease management initiatives.
Responds to CMS risk adjustment data validation audits.
Provides diagnostic coding education tailored to health care professionals based on audit findings of their medical documentation.
Performs other duties as assigned.
Bachelors Degree or combination of relevant education and experience.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
5+ years medical coding experience in a medical/surgical setting, or 5+ years of billing/coding experience in a facility setting.
Experience with CMS Medicare Advantage Risk Adjustment
Expert knowledge of ICD-9/10 CM coding guidelines
Strong auditing skills, specific to Medicare Risk Adjustment
Excellent written and verbal communication skills required
Strong problem solving skills
Strong organizational skills
Proficiency with Microsoft office products, specifically Excel, Word and Access
Exceptional Customer Service skills
Ability to relate to different types of people and build constructive and effective relationships
Ability to work independently with minimal supervision
Ability to exercise independent discretion and judgment to make coding decision having significant financial implications to the health plan
TRAVEL REQUIREMENTS: Travel required but limited to Maine and New Hampshire. Amount of travel can range up to 70% of scheduled time on any given month of the year.
Must have valid state driver license and be able to drive a car.
Must have proof of adequate automobile insurance coverage for the state of residence.
Must be able to independently travel to assigned locations and work from remote locations.
We are an equal opportunity/affirmative action employer.