Job Description

JOB SUMMARY:  These are certified coding professionals who perform gap assessments, ensure coding compliance, and monitor that artificial intelligence (AI) containers are performing optimally and correctly. They are the first point of contact with the participating providers and work to ensure that the clinical workflow optimizes the RemitOneTM services provided.

ESSENTIAL RESPONSIBILITIES

·        Review and analyze patient encounter records for pertinent data

·        Conduct timely, accurate, and comprehensive review of corresponding clinical documentation and services performed.

·        Apply ICD-10-CM, CPT, and HCPCS codes, as supported by the medical record, for Professional/Outpatient services

·        Abide by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in reference to all confidential information obtained through job tasks.

·        Listen to live and/or recorded patient encounters to properly document and code the clinical visit

·        Provide real-time feedback to providers regarding clinical documentation accuracy and completeness. This includes:

o   Verifying provider has properly verbalized all required components for a patient encounter

o   Support assigned providers with coding and clinical documentation queries

·        Perform chart review with providers for education on compliance

·        Successfully complete all designated MCC training modules

·        Achieve and maintain a 95% quality and productivity scores in accordance with AHIMA accuracy benchmarks

·        Attend and participate in organizational-wide and team meetings

·        Perform special projects as assigned

MINIMUM QUALIFICATIONS

·        AA/AS in Health Information Management and at least 3 years’ experience or, in lieu of degree, 5 years’ experience in Outpatient medical coding, auditing, training, and education

·        Must be an accredited Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist – Professional (CCS-P) through the American Health Information Management Association (AHIMA)

·        Must be ICD-10-CM, CPT, and HCPCS proficient

·        Proficient experience working in clinical information systems/electronic health records, computer assisted coders (CAC), and encoder systems

·        Advanced knowledge of medical coding and documentation requirements

·        Expertise in medical coding guidelines and regulations, including compliance and reimbursement

·        Proficient across a wide range of specialties to include internal medicine, family medicine, behavioral health, anesthesia, pain medicine, and orthopedics

·        Expertise in reviewing clinical information and assigning accurate medical codes for diagnoses, procedures, and services performed by physicians and other qualified healthcare professionals 

·        Comprehensive knowledge of anatomy, physiology, pharmacology, and medical terminology

JOB-SPECIFIC COMPETENCIES

·        Expert level Federal, State, and Commercial payor knowledge, including compliance and reimbursement guidelines

·        ICD-10-CM, CPT, HCPCS

·        Proficient in Evaluation and Management (E/M) guidelines

·        Familiarity with proof-reading clinical transcripts and medical documentation

·        Comprehensive knowledge of anatomy, physiology, pharmacology, and medical terminology

·        Comfortable with audio recording software (e.g., dictation software), healthcare clearinghouses, HIPAA compliant messaging, and tablet applications (e.g., iOS applications)

WORK ENVIRONMENT

Med Claims Compliance Corporation is committed to diversity, equity, and inclusion in all employment practices. We offer flexible hybrid schedules with remote office options.

EMPLOYEE ACKNOWLEDGEMENT

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

I have read and understand the contents of this job description and am able to perform all essential responsibilities without accommodation.  Should this change, I will provide my request for reasonable accommodation in writing supported by a physician statement to Human Resources.