Skills and Requirements:
- Should have active CPC License (active within 6 months). Okay even WITHOUT USRN/ PHRN license.
- Should have atleast 1 year medical coding experience to be qualified for CL11. Okay with no work experience/1 year below/CL12 (willing to amend if any).
- Ability to code using ICD-10 code book (without using an encoder).
- Computer proficiency (including MS Windows, MS Office, and the internet)
- Knowledge of HIPAA recognizing a commitment to privacy, security and confidentiality of all medical charts.
- Strong clinical skills related to chronic illness diagnosis, treatment and management
- Knowledge of HCC concepts and impact on Population Health Risk
- Adjustment reimbursement initiatives.
- 2 years claims operations and/or customer service (BPO or Non BPO, preferred BPO)
- Abstracts, sequences and assigns diagnosis and procedure codes according to the Center for Medicare & Medicaid Services - Hierarchical Condition Categories (CMC - HCC), Department of Health and Human Services - Hierarchical Condition Categories (DHHS-HCC) and all CPT and ICD 9 & 10 guidelines.
- Conducts thorough review of charts by assigning ICD codes, selecting the status and evidence for the Dx, and applying deletion reasons for Dx codes identified
- Effectively uses computer assisted coding tools to review and interpret medical records and applies in-depth knowledge of coding principles to validate missing, incomplete or incorrect CPT and diagnosis codes
- Demonstrates advanced knowledge of medical terminology, anatomy and physiology to identify all appropriate coding based on Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) and Department of Health and Human Services - Hierarchical Condition Categories (HHS-HCC) models.
- Manages individual quality of work & productivity toward meeting or exceeding targets
- Performs administrative tasks and work as directed by Team Lead/Operations Lead/Quality Lead. Consults clinician and Team Lead/Operations Manager timely and appropriately
Interested and Qualified candidates should forward their resume and cover letter to firstname.lastname@example.org, using the job title as the mail subject.
CPC License, HIPAA, ICD - 10, Claims Operations, Customer Service
12:00 AM to 12:00 AM
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