Professional Coder

Job Title:

Professional Coder I
Position:
Fully Remote

Note:

Potential temp-perm so must be local to client location

Description

Summary:

• 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.
• 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.

• 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.
• Maintain department productivity and accuracy standards.

• 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).
• 2 – 5 years of Medical Coding experience.
• Minimum of 2 years’ experience in Health Insurance/quality chart audits and/or Utilization Review.
• Bachelor’s degree preferred.

• Proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding.
• Knowledge of medical terminology, medical procedures, abbreviations, and terms.
• Knowledge of the healthcare delivery system.

• Ability to utilize a personal computer and applicable software (e.g., proficiency in Word and Excel).
• Effective verbal and written communication skills and the ability to work well within a team.
• Demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
• Proven ability to exercise sound judgment and problem-solving skills.
• Proven ability to ask probing questions and obtain thorough and relevant information.

Axelon Services