HCC Coding Specialist - Exempt Covina

Job Summary

Responsible for the oversight of HCC Program and STAR measures coding related functions. The coding specialist will work with the IPA Director, Health Plan, and MSO personnel on HCC and STAR measures related tasks. Responsible to ensure the IPA risk adjustment factor maintains or exceeds 1.0 and achieves or improves upon 4.0 STAR rating. The coding specialist is responsible for education to external physician offices and works closely with physicians and billers to ensure the appropriate ICD
10 and CPT codes submitted for Medicare and Covered CA lines of business. Coding specialist will be responsible to review medical records and claims data to ensure external physicians are documenting correctly and submitting the correct ICD-10/CPT codes. Responsible for summaries and presenting information in a professional and effective manner. Assigns diagnostic/procedural codes to in- patient and outpatient medical records. Ensures that all accounts are coded accurately and timely.

Follows-up on un-coded accounts. Researches and helps resolve problem accounts.

• Minimum Education Requirement:
  Associate degree preferred; college degree preferred with coursework in Medical Terminology, Anatomy & Physiology and Computer experience.
• Minimum Experience Requirement:
  Must have at least one year of experience in Medicare HCC program within IPA, HMO, or clinic setting. Two to five years of coding experience using ICD-9, ICD-10 and CPT coding systems. Excellent customer service skills required.
• Minimum License Requirement: CMC, CCS, CPC, or COC required.

Delivering world-class health care one patient at a time.

Pay Range: $33.00 - $48.87