Business Office Certified Risk Coder-Full Time [United States]

 

Job Summary

Responsible for correctly coding healthcare claims in order to obtain reimbursement from insurance companies and government healthcare programs.

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Organizational Expectations

Provides a positive and professional representation of the organization.

Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.

Maintains standards for a clean and quiet patient environment to maintain a positive patient care experience.

Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.

Adheres to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.

Participates in ongoing quality improvement activities.

Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.

Complies with organizational and regulatory policies for handling confidential patient information.

Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization.

Adheres to professional standards, policies and procedures, federal, state, and local requirements, and/or standards from other accrediting bodies, such as The Joint Commission, Rural Health, and Center for Medicare Services.

As a Studer Partner must have the ability to develop a full understanding of the Studer Group practices and tools and communicate effectively. Must embrace the Studer Philosophy and Principals by conducting him/herself in a professional manner. Will be held accountable for Studer Philosophies and Principles to include:

• Patient Perception
• AIDET
• Daily Huddles

Essential Functions

Customer Services:

• Educate providers and their staff in Medicare coding guidelines, with special focus on revenue enhancement opportunities
• Develop plans and materials that support the educational and training needs of the medical practice, by collaborating with internal departments
• Communicate with providers to ensure that correct codes are chosen and add required updates
• Provide coding and guideline education to all coders and providers

Business Services:

• Review medical records and decipher if they are accurate and complete, accurate and in support of patient risk adjustment score accuracy
• Provides regular feedback to Operations leadership on performance improvement opportunities as a result of performance gaps.
• Oversee medical records and correct incomplete or incorrect codes for both active and previous conditions
• Review medication list to verify if there is a correlating condition or if an active condition is being treated with medication
• Ascertain that all specialist and hospital consults and lab, radiology and pathology reports are properly reviewed
• Audit documentation including confirming each condition or screening that is marked as assessed
• Assigns ICD-10, CPT, and HCPCS codes based on provider documentation.
• Ascertain that coding efficiency and accuracy is improved by performing independent audits of physician and hospital records
• Develop tools and metrics to ensure that the accuracy and completeness of coding and documentation is improved
• Perform chart reviews, aimed at identifying missed diagnosis in all applicable healthcare settings

Environmental Services:

• Contributes to the overall cleanliness and appearance of personal workspace and department.
• Monitors supply levels and requests when needed.
• Maintains all equipment. Evaluates all equipment for damage or maintenance needs and reports when needed.

Non-Essential Functions/ Marginal Duties

All other duties as assigned

Required Skills

Skills:

• Communication Excellence
• Knowledge and ability to work in accordance federal and state regulations
• Strong knowledge base of medical terminology, medical abbreviations, pharmacology, and disease processes.
• Must have knowledge with coding Medicare Annual Wellness Visits.
• Ability to work tactfully and effectively with patients, family members, other employees and physicians.
• Analytical abilities
• Word Processing / Computer
• Strong customer service
• Multi-tasking
• Time Management
• Organization
• Attention to Detail
• Professionalism / Positive Attitude
• Quality Focus
• Adaptability

Required Experience

Minimum Education: Graduate of a certified risk coder program

Work Experience: One year or more experience as a risk coder or insurance payer risk auditor

Required License/ Certification/Registration: Certified Risk Coder or comparable designation

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