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Medical Coding Quality Assurance Specialist
6 days agoPayCompetitive
LocationRemote
Employment typeFull-Time
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Job Description
- Req#: R-106551
- Performs validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
- Performs quality reviews of coding vendor and/or coding teamwork activities to ensure all collected data is accurate, complete, and compliant with state and federal regulations as well as Official Guidelines for Coding and Reporting and Capstone defined coding policies and procedures.
- Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.
- Identifies and reports issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding guidelines and CMS HCC Categories
- Assigns and sequences ICD codes to diagnoses for documented information. Performs final review and revision of ICD-10 codes in Client's EMR. May perform ICD-10 code entry when necessary, into client's EMR.
- Maintains 95% accuracy rate.
- Appropriately uses coding principles to code to the highest specificity and complies with CMS regulations and company goals and policies.
- Upon completion of audits, compiles detailed findings and prepares reports.
- Provides audit results and shares recommendations for course-correction and education as needed. Analyzes coded data to determine trends and root cause for variations.
- Performs reviews for prospective and retrospective audits when requested.
- Participates in workgroups/committee meetings and process improvement solutions as required.
- Advises Director of Coding and Auditing of possible trends in inappropriate utilization (under and/or over) and other quality of care issues.
- Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise.
- Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association; or Certified Professional Coder (CPC) or Certified Technologist (RHIT)
- Minimum 3 years coding experience (except RHIT) with a minimum of 2 years' experience with Risk Adjustment Coding (HCC)
AnewHealth is one of the nation's leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs-wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.
Job Details
We are seeking a Medical Coding Quality Assurance Specialist. This position performs highly technical and specialized functions for Capstone. The Medical Coding Quality Assurance Specialist performs quality audits for coding data to ensure compliance with Coding guidelines, as well as departmental policies and procedures. The primary function of this position is to ensure compliance in maintaining 95% coding accuracy for all coding staff. Additionally, this position analyzes findings and provides feedback and support for training and clinical documentation improvement.
Responsibilities
Qualifications
AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.About the company
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