HCC Coder - FT - Days - MPC - Hybrid Eligible at Memorial Healthcare System in Hollywood, Florida

Job Description:

Location:

Hollywood, Florida


At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.



Summary:



The Hierarchical Conditioning Coding (HCC) Coder is responsible for reviewing medical records and practice management code data and make recommendations to providers as needed. Knowledge of medical coding guidelines, regulations, and understanding the impact of diagnosis coding on risk adjustment payment models.



Responsibilities:



Synthesize data and questions to communicate a cohesive educational training program for the organization. Trains billing, I.T. providers and leadership on changes to appropriate coding.Reviews HCC Coding work queues daily to address coding edits and needed corrections and follows procedures to notify billing as needed.Reviews internal and external medical records and determines if the medical record is complete, accurate, and in support of individual patient risk adjustment score. Codes will be sequenced and assigned from electronic medical systems such as International Classification of Diseases ICD-10, HCC Risk coding software, and AHA coding clinic software based on the code which most accurately describes each documented diagnosis.Reviews Medicare Call Letter to ensure all upcoming changes are shared with billing, I.T., providers and leadership.Educates providers and their practice staff in Centers for Medicare & Medicaid Services (CMS), Health and Human Services - Affordable Care Act (HHS-ACA) and the Agency for Healthcare Administration (AHCA) coding guidelines. Focusing on documentation and accurate codes to enhance revenue opportunities.Reviews medical coding guidelines and regulations allowing a CRC to understand the impact of diagnosis coding on risk adjustment payment models including HCC, Chronic Illness Disability Payment System (CDPS)- Medicaid, Affordable Care Act (ACA-HHS)-Commercial payer models.Reconciles internal and external reports to ensure pre or post review of each medical record is completed. Communicating recommendations to providers as appropriate, following up when necessary.Works in collaboration with other departments, develop plans and materials that support education and system changes to meet practice and revenue goals.Formulates physician queries for validation of pathological/clinical findings, Request clinical validation queries for Clinical Documentation integrity (CDI) review and follow-up. Seeks clarification from providers or other designated resources to ensure accurate and complete coding.Utilizes payor portal to identify missed, dropped or suspect HCC opportunities, and assigns appropriate coding disposition. Utilizes mining from data captured through historical risk adjustment coding reports.



Competencies:



ACCOUNTABILITY, ACCURACY - CODER, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, HEALTH INFO MANAGEMENT, MEDICAL CODING - QUALITY, MEDICAL TERMINOLOGY (4), RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR



Education and Certification Requirements:



High School Diploma or Equivalent (Required)Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)



Additional Job Information:



Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills. Works with sensitive data and relay potential issues or concerns in a diplomatic manner. Required Work Experience: Three (3) years of Hierarchical Conditioning Coding. Other Information: **Can be certified in Risk Coding (CRC) or Professional Coding (CPC) or Outpatient Coding (COC).Additional Credential Info: Certification in Risk Coding (CRC) or Professional Coder (CPC) or Outpatient Coding (COC).



Working Conditions and Physical Requirements:

• Bending and Stooping = 40%


• Climbing = 0%


• Keyboard Entry = 60%


• Kneeling = 40%


• Lifting/Carrying Patients 35 Pounds or Greater = 0%


• Lifting or Carrying 0 - 25 lbs Non-Patient = 40%


• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%


• Lifting or Carrying > 75 lbs Non-Patient = 0%


• Pushing or Pulling 0 - 25 lbs Non-Patient = 40%


• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%


• Pushing or Pulling > 75 lbs Non-Patient = 0%


• Reaching = 40%


• Repetitive Movement Foot/Leg = 0%


• Repetitive Movement Hand/Arm = 60%


• Running = 0%


• Sitting = 60%


• Squatting = 40%


• Standing = 60%


• Walking = 60%


• Audible Speech = 60%


• Hearing Acuity = 60%


• Smelling Acuity = 0%


• Taste Discrimination = 0%


• Depth Perception = 60%


• Distinguish Color = 60%


• Seeing - Far = 60%


• Seeing - Near = 60%


• Bio hazardous Waste = 0%


• Biological Hazards - Respiratory = 0%


• Biological Hazards - Skin or Ingestion = 0%


• Blood and/or Bodily Fluids = 0%


• Communicable Diseases and/or Pathogens = 0%


• Asbestos = 0%


• Cytotoxic Chemicals = 0%


• Dust = 0%


• Gas/Vapors/Fumes = 0%


• Hazardous Chemicals = 0%


• Hazardous Medication = 0%


• Latex = 0%


• Computer Monitor = 80%


• Domestic Animals = 0%


• Extreme Heat/Cold = 0%


• Fire Risk = 0%


• Hazardous Noise = 0%


• Heating Devices = 0%


• Hypoxia = 0%


• Laser/High Intensity Lights = 0%


• Magnetic Fields = 0%


• Moving Mechanical Parts = 0%


• Needles/Sharp Objects = 0%


• Potential Electric Shock = 0%


• Potential for Physical Assault = 0%


• Radiation = 0%


• Sudden Decompression During Flights = 0%


• Unprotected Heights = 0%


• Wet or Slippery Surfaces = 0%

Shift:




Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.


Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.


Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.


Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.


We are proud to offer Veteran's Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.


Employment is subject to post offer, pre-placement assessment, including drug testing.


If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net Apply Now