For the purposes of complete accurate clinical documentation, reimbursement, reporting and research, follows established guidelines, policies and procedures, in accordance with all Federal & State coding rules, regulations and reporting requirements. Codes all payer types as needed according to diagnoses, operations and procedures using appropriate classification systems. Abstracts designated demographic and clinical data for profiling and benchmarking. Ensures correct code assignment, modifier use, and sequencing to provide for maximum accuracy & completeness of clinical documentation and allowable reimbursement. Appropriate and professional communication with medical providers to provide ongoing education and feedback to obtain optimal documentation to meet coding and compliance standards
Essential Functions and Responsibilities of the Job
Identify HCC improvement opportunities
Develop and monitor group specific HCC improvement plan for each physician group
Perform chart reviews focused on identifying missed diagnoses in all applicable health care settings
Improve coding accuracy by performing independent audits of physician and hospital records
Develop tools for improved accuracy of coding and documentation
Provide input and expertise for coding best practices.
Be at work and be on time
Follow company policies, procedures and directives.
Interact in a positive and constructive manner.
Prioritize and multitask.
Essential Job Outcomes
Analyze and interpret medical information in the medical record and ensures the records have been appropriately ICD-9-CM/ICD-10-CM coded to the highest level of specificity.
Identify opportunities for billing and coding improvements. Participate in developi ng, implementing and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs.
Interact with, and provide support to physician's office and facility staff, answer questions, and assist with any risk adjustment related issues. Work as a team player and communicate in a positive manner with co-workers, managers, providers, and other contacts.
Employ strong understanding of the encounter/billi ng process, and CMS and health plans' Risk Adjustment Data Validation (RADV) projects. Utilize medical reference resources and contacts to thoroughly research coding issues. Maintain working knowledge of CMS-HCC risk adjustment model and COPS risk adjustment model, to ensure maximum reimbursement and coding compliance.
Provide ongoing education and feedback to MCMF physicians, to obtain optimal documentation and meet coding and compliance standards. Assist and participate in the organization's training efforts regarding ICD-10-CM.
Take responsibility for various projects as assigned by management. Perform any additional or miscellaneous duties (not inclusive of job description), as requested by the management team, and within the scope of knowledge and ability.
Other duties as assigned.
This position is located in Fountain Valley, CA. This is not a telecommute position.
Minimum 3 years’ experience working in a hospital or physician’s office as a medical coder and interacting with physicians;
Minimum 2 years’ experience as a surgical coder;
Expert knowledge of ICD10, CPT and HCPCS
High school graduate or equivalent;
CPC, CCS, RHIT, or equivalent certification;
Specialty coding certification required
Internal Number: MEM003621
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.