CPC Medical Coder

Confidential Company  •  Philadelphia, PA

5 - 7 years experience  •  Managed Care & Health Insurance

Salary depends on experience
Posted on 08/08/17
Philadelphia, PA
5 - 7 years experience
Managed Care & Health Insurance
Salary depends on experience
Posted on 08/08/17

Position: Risk Adjust Spec Coder - CPC

Location: Building 200, Philadelphia, PA, 19113

Duration: Full time 

Required skills:

High School diploma and Certified Professional Coder certificate required.

Required

Experience performing medical record abstraction.

Required

5

Years

Experience in medical billing or claim review/analysis.

Required

2

Years

Superior knowledge of CPT, HCPCS, ICD 9 coding systems.

Required

CPC designation by American Academy of Professional Coders or similarly accreditez organization.

Required

Valid Driver’s license and reliable automobiletransportation for on-site assignments and off site work related activities.

Required

Complete Description:

High School diploma and Certified Professional Coder certificate required.

5 or more years’ experience performing medical record abstraction required

2-3years’ experience in  medical billing or claim review/analysis required

Superior knowledge of CPT, HCPCS, ICD 9 coding systems required

Certified Professional Coder: CPC designation by American Academy of Professional Coders or similarly accredited organization

Valid Driver’s license and reliable automobiletransportation for on-site assignments and off site work related activities

Analyzes historical claim data to identify coding deficiencies and performs chart abstracts to support revised claim submissions from providers for accurate diagnosis code data.

Abstracts charts in provider offices. Uses knowledge of ICD-9/ICD-10 and CPT coding to support additional diagnosis or increased diagnosis specificity should be documented on claim records.

Schedules on-site visits and medical record reviews maintaining a minimum of 80 – 125 records reviewed per day

Maintains quality standards as defined by departmental policy

Facilitates submission of updated provider claim records, with provider approval, based on data abstracted from medical records ensuring claim data integrity

Functions as liaison to other Health Plan areas as required to support chart abstraction and documentation

Adheres to reporting requirements and accurately provides and tracks data used for reporting purposes, monitors the volume of incoming work and production within the required timeframe.

Self-monitors workflow and takes appropriate action to assure turnaround requirements are met.

Makes Supervisor and/or Manager aware of deterrents to successful accomplishment of job requirements in a professional manner and offers suggestions for improvement.

Utilizes knowledge of CMS, ICD9-CM and CPT guidelines to deliver in-service training presentations for KMHP/AMHP providers.

a.       Remains current with HCPCS, CPT-4, ICD-9, DRG, Medicare and NCQA guidelines and regulations regarding correct coding procedures

b.      Creates documentation/presentations as required to educate contracted providers on appropriate medical record documentation and coding techniques

c.       Participates in meetings with clinical and or administrative staff of contracted providers to deliver training, field questions and respond to issues

Interacts with associates at AmeriHealth Caritas as required to support maximization of risk adjustment revenue via encounter diagnosis optimization.

a.       Coordinates with Community Outreach Services Team Leaders to facilitate member appointment availability, transportation needs, appointment compliance issues or update of member demographic data

b.      Demonstrates an in-depth understanding of provider policies/regulations and procedures and stays current with all updates and revisions

c.       Coordinates with Provider Network Management as necessary to resolve provider related issues identified during on-site visits

d.      Uses sound judgment to differentiate between those issues that can be resolved personally and those that require the assistance of supervisor or otherassociates

•         Performs other job related duties and projects as assigned.

•         Supports and carries out corporate Mission & Values.

Work Environment:

A portion of this job is performed out in the field using a motor vehicle to get to and from provider office visits and dealing with the outside climate.  Some work is performed in an open office setting.

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