Coding Specialist Level II

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POST DATE 9/14/2016
END DATE 10/13/2016

Health Choice Phoenix, AZ

Phoenix, AZ
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
High School Diploma or GED


JOB SUMMARY: The Level II Coding Specialist is to perform medical record reviews and abstract codes effectively from medical records for the purpose of ensuring quality and timely care of our members as well as correct reimbursement. Codes will be sequenced and assigned from ICD 9 / ICD 10 CM based on the date of service which most accurately describes each documented diagnosis. This position will measure accuracy, consistency and efficiency of our Encounter Data Processing System (EDPS) as well as Marketplace risk adjustment activities. Encounters that do not link to supplemental data will be tracked and analyzed to identify trends, summarize findings, and improve linking process. EDPS analyzing will require extensive knowledge in CPT, HCPCS and ICD-9/10 CM coding.

Job Responsibility:
Conducts medical charts and claims audits, identifying opportunities for improving individual member risk adjustment score accuracy.
*Comprehensive understanding of HCC Coding rules, regulations and methodology
*Accurately and efficiently conduct medical record review/abstraction services.
*Review Encounters for data validation and linking purposes
*Perform work duties remotely, working on site as necessary for additional training and on-going education.
*Goal of 95% Accuracy on QA Audits
*Must have comprehensive understanding of: the contents of a typical medical chart, medical terminology and abbreviations, ICD 9/10 CM, CPT, HCPCS coding conventions and guidelines, what constitutes adequate substantiation of a diagnosis, CMS acceptable documents and facilities for proper code capture.

Expected Outcomes:
*Complete quality and accuracy maintaining industry standard of 95% or better in QA audits.
*Communicate effectively and professionally with care provider offices, clinics, hospitals, other clinical facilities and Health Choice staff.
*Maintain coding certification and keep up to date on industry changes.
*Abide by all HIPAA and associated patient confidentiality requirements.
*Optimize our RA scores.
*Provide feedback to Clinical Correlations and Manager on provider education needs.

Health Choice exists to improve the health and well-being of the individuals we
serve through our health plans, integrated delivery systems and managed care
solutions. We strive to recruit and retain only the finest health care
professionals with the highest levels of integrity, compassion and competency.
If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment while still
being valued for your individual strengths Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled
Professional Competencies (knowledge, skills, and abilities):

*Knowledge of anatomy and physiology/major disease processes/pharmacology
*Knowledge of understanding etiology, pathology, signs and symptoms, diagnostic studies and treatment modalities
*Ability to work remotely from home (maintaining high speed internet as required).
*Knowledge of CMS and Commercial Health Plans
*Strong customer service skills and techniques.
*Strong knowledge of HEDIS measures and their requirements
*Strong oral and written communication skills.
*Strong knowledge of risk adjustment/HCC, CPT, HCPCS coding
*Ability to effectively interact with staff, customers and management at all levels.
*Maintains agreed upon work schedule
*Demonstrates flexibility and willingness to embrace change

Clinical training (Medical Assistant, Registered Nurse, Licensed Practical Nurse, or Certified Nursing Assistant) preferred
College degree preferred

At least three (3) years of coding experience; Clinical experience also preferred

Certification and License:
Certified as CPC, CRC, CCS, CCS-P, CCS-H, CPMA or RHIT

Job: Coder
Primary Location: Arizona-Phoenix
Organization: Health Choice
Education Level: High School Diploma/GED
Employee Status: Full Time Benefit Eligible 36-40 hrs/wk
Work Schedule: Days