Medical Coding Analyst

Coding Analyst

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources. HCP's vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP's mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a Coding Analyst!

Position Summary: The Coding Analyst will provide Risk Adjustment/HCC coding and auditing services that include the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated alphanumerical codes. The Medical Coder will summarize audit results and provide feedback and education to the field team and providers regarding documentation needs and requirements.

• Review and interpret medical record documentation to identify pertinent diagnoses and procedures and assigns ICD-10 CM and CPT 4 codes accurately and timely to the highest level of specificity based upon physician documentation.
• Verify and ensure the accuracy and completeness of medical records while extracting appropriate and specific ICD-10 CM- CPT and Category II codes.
• Apply relevant Medical Coding Reference, Federal, State, and Professional guidelines to assign and record independent medical code determinations.
• Review coding patterns/trends and provides ongoing consultation to the field Quality/ Network Relations team regarding coding and documentation issues.
• Proactively identifies and communicates problems and opportunities; actively recommends and implements solutions or medical coding process improvements.
• Interpret coding rules and general policies in addition to determining appropriate conclusions.
• Determine valid encounters including legibility and valid signature requirements.
• Provide information or respond to questions from medical coding quality audits.
• Possess and maintain a current and comprehensive understanding of coding rules, changes, and guidelines as defined by the AMA.
• Responsible for consistently meeting established quality and productivity standards.
• Other duties relating to coding projects as assigned.

Qualification Requirements: Skills, Knowledge, Abilities

• Experience working in medical coding/auditing with experience in Diagnosis coding
• Knowledge of medical terminology including anatomy and physiology...
• HCC and risk adjustment model experience strongly preferred
• Strong background in ICD 10 Coding
• Knowledge and understanding of CPT and CPT II (HCSPCS) codes
• Intermediate level of experience with Microsoft Excel (Pivot table, building chart)
• Strong written and verbal communication and organizational skills
• Must present active AAPC or AHIMA membership ID #
• Proficient with Excel and MS office products
• Demonstrates the ability to perform in a high productivity fast-paced environment.
• Knowledge of ICD-10 CM Guidelines and CMS Risk Adjustment Guidelines
• Knowledge of Risk Adjustment Coding

Training/Education:

• High school diploma or general educational degree (GED), required
• Associate or Bachelor degree in health care discipline, preferred
• Medical coding Credentials through either AAPC or AHIMA (CCS, CCS-P, or CPC) maintained annually, required.
• CRC or CPMA credentials, preferred
• Proficient in navigating an electronic medical record and healthcare billing system

Experience:

• 3+ years' of inpatient facility coding experience with both quality and productivity requirements
• 3+ years' of outpatient facility coding Auditing experience is preferred
• 1+ year of inpatient and/or outpatient facility coding experience
• 1+ year of auditing experience preferred
• Knowledge of Risk Adjustment coding
• 1 year of healthcare provider education experience

Base Compensation: $65,000 - $75,000 annual HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. The above position information is intended to describe the general nature and level of work being performed by the job incumbent(s) and is not to be considered an all-encompassing description of all responsibilities, duties, and skills required.