How will this role have an impact?
Under the supervision of the Sr. Coding Manager, this position is responsible for ICD-10 coding of health risk evaluations of Medicare and Medicaid members that are performed by the Company, and reviewing the coding of health risk evaluations, coded both internally and externally, to insure completeness, accuracy and compliance with CMS guidelines. In addition, the Coding Auditor audits Coding Specialists’ coding work output.
Essential Job Responsibilities:
- Reviews health risk evaluations within required timelines to determine completion and compliance with CMS guidelines
- Reviews and assesses the accuracy, completeness, specificity and appropriateness of diagnosis codes identified in the health risk evaluations
- Reviews health risk assessments/evaluations to accurately and completely assign all ICD-10 codes that are clinically identified and supported in the assessment/evaluation on a timely basis.
- Communicates timely and effectively with the Director of Coding, Coding Coordinators and Group Leaders regarding issues or corrections with the health risk evaluations.
- Understands the relationship between ICD-10-CM coding and HCC (hierarchical condition categories) coding
- Utilizes advanced, specialized knowledge of medical codes and coding protocol by collaborating with the Director of Coding and coding staff to ensure the organization is following Medicare coding protocol for payment of claims.
- Demonstrates a commitment to integrating coding compliance standards into coding practices .
- Identifies, corrects and reports coding problems
- Maintains adequate knowledge of coding, compliance and reimbursement procedures related to Medicare risk adjustment
- Makes recommendations for coding policy/changes
- Maintains coding certification after achieving certification status.
- Completes special projects as assigned by the Director of Coding or designee which require defining problems and implementing required changes.
- Follows all legal and policy requirements for HIPAA protected data.
- Actively demonstrates teamwork at all times.
- Strong familiarity with the Coding Clinic.
- Is able to index conditions accurately and appropriately
- Must meet and maintain productivity and accuracy targets.
- Expert level understanding of coding guidelines and is able to use and apply appropriate judgement.
- Minimum 4 years of coding audit experience
- Minimum 6 year ICD-10 coding experience.
- Prior work experience in the healthcare field specifically related to coding is preferred.
- Experience and knowledge of Medicare HCC coding
- Experience with medical record documentation.
- Prior medical chart auditing/quality experience required.
- Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
Essential skills and certificates:
- Certified Coding Associate ( CCA ), Certified Coding Specialist ( CCS), Certified Coding Specialist for provides ( CCS-P) or Certified Professional Coder ( CPC)
- CRC required
- ICD-10 Coding Certification
- Credentials of at least 6 years by AHIMA or AAPC required. Credentials must be current and maintained during employment.
- Current coding certificate in a good standing.
- Knowledge of CMS RADV protocols
- High school diploma or equivalent. Associate's or Bachelor Degree proffered.
- Basic skills in MS Office
- Basic analytical skills
- Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology
- Knowledge of CMS medical record and ICD-10 coding guidelines
The base salary hiring range for this position is $18.89 – $38.13/HR. Compensation offered will be determined by factors such as location, level, job-related knowledge, skills, and experience. Certain roles may be eligible for incentive compensation, equity, and benefits.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. Eligible employees may enroll in a full range of medical, dental, and vision benefits, 401(k) retirement savings plan, and an Employee Stock Purchase Plan. We also offer education assistance, free development courses, paid time off programs, paid holidays, a CVS store discount, and discount programs with participating partners.
Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across individuals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for individuals who need help the most. This leads to better outcomes and a better experience for everyone involved.
Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million individuals each year while helping payers and providers more effectively implement value-based care programs.
To learn more about how we’re driving outcomes and making healthcare work better, please visit us at www.signifyhealth.com.
We are committed to equal employment opportunities for employees and job applicants in compliance with applicable law and to an environment where employees are valued for their differences.
Diversity and Inclusion are core values at Signify Health, and fostering a workplace culture reflective of that is critical to our continued success as an organization.