Upon regularization HMO for you PLUS 1 dependent worth P150,000
Role Summary
1
Responsibilities
Performs quality assurance review on a pre-determined percentage of completed medical records to monitor coding accuracy, completeness, and thequality of HCC coding performed by AI-Risk Coding Associates to ensure compliance with all CMS and ICD-10-CM coding guidelines for Medicare Advantage Risk Adjustment
Maintains current knowledge of ICD-10-CM coding guidelines and CMS Medicare Advantage Risk Adjustment documentation guidelines.
Serves as a resource for clarification of coding guidelines to junior coding staff
Works with onboarding new coding staff to ensure coding per department policies, processes, and procedures
When needed in overflow situations conducts thorough review of charts by effectively using computer-assisted coding tools to review and interpret medical records, and applies in-depth knowledge of coding principles to assign valid diagnosis codes which are supported by evidence in the medical record on the same date of service
Manages individual quality of work & productivity toward meeting or exceeding targets
Performs work as directed by Team Lead/Operations Lead
Consults Team Lead/Operations Manager and/or Coding SME timely and appropriate as-needed
Qualifications
The ideal candidate must possess a Bachelor of Science in Nursing, Other Allied Health graduate, Associate Degree or equivalent HCC coding experience
Must holds and maintains active Certified Professional Coder (CPC) and/or Certified Risk Adjustment Coder (CRC) certification through the American Academy of Professional Coders OR Certified Coding Specialist (CCS) and/or Certified Coding Specialist – Physician based (CCS-P) through American Health Information Management Association (AHIMA)
Must have a minimum of 3 years of experience in risk adjustment coding
Knowledge of Hierarchical Condition Code concepts
Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical records and member information
Knowledge and demonstrated understanding of CMS HCC Risk Adjustment coding and data validation requirements preferred
EMR/EHR experience preferred
Related outsourcing/vendor operations experience preferred
Computer proficiency (including MS Windows, MS Office, and the Internet)
Ability to use an official ICD-10-CM code book or Encoder software which corresponds to the date(s) of service being reviewed to assign diagnosis codes appropriately and according to official guidelines and section/chapter level instructions
Knowledge of and ability to apply ICD-10-CM outpatient diagnosis coding guidelines
Must be amenable to undergo 2 weeks of face-to-face training in BGC, Taguig. After training, will then proceed to a hybrid setup
