HCC Coding Specialist

Company: Crystal Run Healthcare LLP
Location: Middletown
Posted on: March 13, 2023

Job Description:

Adheres to standards of professionalism set by the Practice. Always maintains professional appearance by adhering to dress code and wearing identification badge. Respects confidentiality and is HIPAA compliant in all aspects of communication regarding patient, Practice and staff members. Functions as a member of a team committed to quality patient care. Takes initiative to keep informed of new/revised Policy and Procedures, Standards of Care
and incorporates these into practice. Handles difficult situations and people with tact, professionalism and H.E.A.R.T. Demonstrates good judgment in escalating difficult situations and people to Management personnel. Attendance & punctuality. Consider number of -unauthorized or unscheduled absences, a pattern of before and after weekend absences, -tardiness and early departures, and -long meal periods -in accordance with -CRHC policy. Operate the department services in line with the Mission, Vision and Core Values of Crystal Run Healthcare
LLP. Concurrently/retrospectively audits medical records to assure compliance with coding and documentation standards, missed HCC codes, as well as quality indicators for risk contracts. Have a comprehensive understanding of ICD-9, ICD-10 and other types of coding to Health Plan, contracted facilities, and providers. - Ensures coding compliance and maximum reimbursement by maintaining a working knowledge of coding guidelines and reporting requirements. Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether: The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe. Identifies members with high risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention. Working knowledge of a Medicare and its impact on reimbursement Uses medical reference resources and contacts to thoroughly research and resolve any coding issues. Proficiency with Windows-based applications with respect to encoder systems, spreadsheets, word processing, databases, etc. Ability to work both independently and as part of a team Integrity: Acts in line with Core Values and beliefs of the Practice. Analysis: Thinks analytically, identifies issues and problems, secures relevant information and organizes
information. Customer Service: Makes efforts to listen and understand the customer (both internal and external), anticipates
customer needs, and gives high priority to customer satisfaction. Delegation: Allocates decision making authority and task responsibilities to appropriate employees, utilizes
employees' time, skills, and potential effectively. Developing Organizational Talent: Develops employees' skills and competencies by establishing goals and
activities, creating opportunities and managing development. Empowerment: Provides support, expands responsibility, communicates openly, adjusts assignments to fit the
person, establishes self-feedback systems, and effectively coaches. Follow-Up: Effectively monitors activities and regulates activities. Individual Leadership (Influence): Establishes rapport, develops ideas, gains commitment, checks for
understanding and agreement, acknowledges people and concerns, and seeks information or suggestions. Initiative: Asserts influence over events to achieve goals; self-starter; takes action to achieve goals beyond
what is required and is proactive. Managing Work: Identifies priorities, manages time, effectively plans, and establishes organized procedures. Negotiation: Effectively explores alternatives and positions to reach outcomes that gain all parties' support and
acceptance. Oral Communication: Expresses ideas effectively in individual and group situations. Written Communication: Expresses ideas clearly with appropriate organization and structure, correct
grammar, language and terminology. Organizational Awareness: Understands and uses the organization's structure, operations, decision making
channels and planning processes to identify potential organization problems and opportunities. Performance Improvement: Understands the concept and philosophy of PI and applies in own area of
responsibility. Adopts quality as a personal responsibility.

Keywords: Crystal Run Healthcare LLP, Middletown , HCC Coding Specialist, Other , Middletown, Connecticut