Professional Coder I

Professional Coder IThis position is accountable for accurately reviewing, interpreting, auditing, coding and analyzing medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction. Review may include inpatient, outpatient treatment and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines and risk adjustment model regulations. This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and Commercial lines of business.Responsibilities:Can understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations.Identify, compile and code member/patient data, using ICD-9/ICD 10-CM and other standard classification coding systems.Support the collection and distribution of documentation and coding improvement tools for designated practice units as applicable.Support educational activities for internal stakeholders as necessary as subject matter expert on coding review/guidelines.Actively participate & engage in program improvement discussions and activities.Maintains department productivity and accuracy standards.Qualifications:Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist, P from the American Health Information Management (AHIMA)Requires 2 - 5 years of Medical Coding experienceRequires a minimum of 2 years' experience in Health Insurance/quality chart audits and/or Utilization ReviewBachelor's degree preferredKnowledge: Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 codingRequires knowledge of medical terminology of medical procedures, abbreviations and termsRequires knowledge of the health care delivery systemSkills and Abilities: Requires the ability to utilize a personal computer and applicable software (e.g. proficiency in Word and Excel)Must have effective verbal and written communication skills and demonstrate the ability to work well within a teamMust demonstrate professional and ethical business practices, adherence to company standards and a commitment to personal and professional developmentProven ability to exercise sound judgment and problem solving skillsProven ability to ask probing questions and obtain thorough and relevant information