• Clinical Coder & Data Entry Coordinator

    Location US-NY-New York
    Posted Date 2 weeks ago(10/10/2018 12:56 PM)
    Job ID
    2018-12275
    # Positions
    1
    Facility
    ArchCare Community Services
    Experience (Years)
    3
    Category
    Administrative
    Work Days Per Week
    5
    Shift
    D
    Shift Start Time
    9:00am
    Shift End Time
    5:00pm
    Type
    Full-Time
    # Hours
    7:30
  • Overview

    The Clinical Coder will perform accurate and timely coding review and validation of HCC’s through medical records.  The Coder will document ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment Guidelines.  Once the ICD-10 codes have been documented data entry will be required to submit claims to the plans 3rd party administrator claims system for adjudication of that claim.  The Clinical Coder will assist the Risk Adjustment HCC Clinical Coding Specialist with projects assigned which will include develop coding related documentation/policies specific to all Medicare & Medicaid Risk Adjustment criteria.    

    Will also be responsible for timely completion of projects, including timeline development & maintenance as it pertains to encounter data.

    Responsibilities

    Minimum of three (3) years with demonstrated sustained coding quality

    Previous experience reviewing medical records for appropriateness code assignment

    Knowledge of government claims processing methodology, ICD-10 and CPT coding guidelines and knowledge State and Federal regulations

    Experience in HCC coding in a managed care setting

    General managed care system knowledge – claims, enrollment, provider, care management

    General knowledge of state and federal regulatory requirements related to plan operations

     Previous experience working in working in a managed care environment (Medicare / Medicaid)

    Qualifications

    MS Office (MS Word, Excel and Access) skills are a must

    Understanding of claims processing and how that impacts encounter files

    Complete appropriate paperwork/documentation/system entry regarding claim/encounter information

    Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information

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