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Coding Compliance Specialist

Company: Christus Health
Location: Irving
Posted on: November 9, 2019

Job Description:

Description
Coding Compliance Specialist will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Coding Compliance Specialist will be involved with activities of auditing and code abstraction for the following programs; including but not limited to, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is an in-office position.



MAJOR RESPONSIBILITIES

Review medical record information on both a retroactive and prospective basis to identify, assess, monitor and document claims and encounter coding information to include the highest level of specificity as it pertains to Hierarchical Condition Categories (HCC)
Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
Identifies revenue, reimbursement, and educational opportunities while remaining compliant with state and federal regulations.
Ensures that rendered physician services for claim submission and any subsequent payments are as accurate as possible while complying with regulatory guidelines including CMS, DHS, and OIG.
Complies with all aspects of coding, abides by all ethical standards, and adheres to official coding guidelines. Conducts physician chart audits to identify incorrect coding, prepares reports of findings and any compliance issues.
Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing.
Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes
Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices to ensure chronic conditions are recaptured annually
Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10-CM manual and other relevant material
Bachelor's degree preferred or equivalent Risk Adjustment coding/auditing.
Health care insurance and medical coding, billing and payment guidelines knowledge required
Intermediate to advanced level of proficiency in Microsoft Excel, PowerPoint & Word.




Requirements
Bachelor's degree preferred or equivalent Risk Adjustment coding/auditing.
Health care insurance and medical coding, billing and payment guidelines knowledge required
Intermediate to advanced level of proficiency in Microsoft Excel, PowerPoint & Word.
3+ years of experience in Risk Adjustment in Medicare Advantage and/or Health and Human Services
At least 2 years of experience in HCC, a clinical, Healthcare operational, or data quality improvement function.
Extensive knowledge of ICD-9-CM, ICD-10-CM/PCS and CPT and HCPCS coding principles and billing guidelines.
Experience in conducting medical record audits reviews required.
Experience with CMS Risk Adjustment Data Validation Audits.
Experience working effectively with common office software, coding software, EMR and abstracting systems
Must have an excellent understanding of medical terminology, disease process and anatomy, and physiology.
Proven ability to prioritized and organize multi-faceted/multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines and turnaround time requirements.
Familiarity with CMS Guidelines & Encounter Data Submission preferred.
Familiarity working with EDGE Encounter Data, EDS Encounter Data & RAPS files.
Certified Medical Coder (CCS, CPC, CCS-P, CRC) through AHIMA or AAPC (required)
CRC (Certified Risk Adjustment Coder) certification, preferred.

Keywords: Christus Health, Irving , Coding Compliance Specialist, Other , Irving, Texas

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