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Central Maine Medical Center Risk Adjustment Clinical Coder in Lewiston, Maine

JOB SUMMARY: The Coder will be responsible for reviewing Central Maine ACO providers' medical record documentation to ensure use of accurate medical coding of all professional, inpatient and outpatient services, procedures, diagnoses and conditions in support of compelte and accurate risk adjustment revenue for applicable ACO populations. The coder will review provider documentation of ICD-9-CM/ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment guidelines. The coder will lead efforts to evaluate the HCC coding practices and provide analyses and recommendations to improve overall provider documentation and coding. The Risk Adjustment Coding Auditor will review medical records to determine if diagnostic codes (ICD-9-CM/ICD-10-CM) are accurately reflecting the provider documentation. The coder will summarize findings for internal and external parties.

DUTIES AND RESPONSIBILITIES:

  • Accurately and efficiently reviews medical charts and assigns the correct diagnosis (ICD-9/10 CM), procedure (CPT), and supply (HCPCS Level II) code for a wide variety of clinical cases and services.

  • Identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories.

  • Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.

  • Review medical record information to identify all appropriate coding based on CMS HCC categories.

  • Effectively communicates with physicians in order to clarify diagnoses/procedures and sequencing of diagnoses.

  • Utilizes specialized coding knowledge and auditing skills to achieve established coding quantity and quality standards.

  • Assesses medical coding practices and suggests areas of improvement for follow up physician training and communication.

  • Performs other duties as assigned.

Regulatory Requirements:

  • Bachelors Degree or combination of relevant education and experience

  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS); Certified Risk Adjustment Coder (CRC) preferred

  • 2+ years of billing/coding experience in a medical/surgical or facility setting

  • Knowledge of diagnoses/procedures in accordance with ICD-9/10-CM coding principles for HCC coding

  • Experience with CMS Medicare Advantage Risk Adjustment preferred

  • Ability to work with physicians and care team staff in a collaborative manner

Language Skills:

  • Ability to read and communicate effectively in English.

  • Excellent written and verbal communication skills required

Skills:

  • Basic computer knowledge - Proficiency with Microsoft office products, specifically Excel, Word and Access

  • Strong problem solving skills

  • Strong organizational skills

  • Exceptional Customer Service skills

  • Ability to work independently with minimal supervision

  • Ability to exercise independent discretion and judgment to make coding decisions

Travel Requirements:

  • Travel to ACO provider physical locations may be required.
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