Coding Specialist

Aledade

Fresno, CA, US
  • Job Type: Full-Time
  • Function: Technical/Customer Support
  • Post Date: 05/06/2021
  • Website: aledade.com
  • Company Address:

About Aledade

Aledade is a new company with an old-fashioned goal: putting doctors back in control of health care. Aledade partners with independent, primary care physicians to provide everything the doctors need to create and run an Accountable Care Organization (ACO) – from business and practice transformation services to upfront capital and a cutting-edge technology platform. Our customized solutions – and our continuous, on-the-ground support of our physician partners – will help doctors in all types of communities across America preserve their autonomy, deliver better care to their patients, reduce overall costs, and keep independent physician practices flourishing.

Job Description

The Coding Specialist is responsible for the effective coordination of all daily coding processes. In addition the Coding Specialist is responsible to provide support to providers regarding coding issues and concerns. The Coding Specialist reports directly to the Billing and Managed Care Director.
 
SUMMARY OF RESPONSIBILITIES:
• Oversee day-to-day operational/billing coding activities.
• Review billing denials related to coding and provide feedback.
• Complete Health Assessment Tools (HAT) forms as assigned by contracted health plans.
• Review Hierarchical Condition Category (HCC) Coding reports provided by health plans. Work with providers to update/correct CPT codes based on report review.
• Review all annual wellness visit (AWV) and Transitional Care Management (TCM) visits encounters to validate coding.
• Work with Quality Improvement (QI) department to review Healthcare Effectiveness Data and Information Set (HEDIS) reports and Merit Based Incentive Payments System (MIPS) reports and identify coding improvement opportunities.
• Ensure coding processes are in compliance with professional standards, state and federal regulatory requirements. • Works with Billing and Managed Care Director and Patient Financial Services Manager to ensure that all expired codes in the fee schedule and in the EMR system are replaced with updated codes on an annual basis.
• Works closely with the providers, billing team and site staff to communicate coding related information and updates.
 
PERFORMANCE AREA 1: Primary Work
• Adheres to the ICD-10-CM (International Classification of Diseases, 10th revision, Clinical Modification) coding conventions, official coding guidelines approved by the Cooperating Parties, the CPT (Current Procedural Terminology) rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets. Selection and sequencing of diagnoses and procedures must meet the definitions of required data sets for ambulatory surgery centers.
• Utilizes up-to-date versions of CPT, HCPCS, CDT, ICD-10 and ICD-9 resources and remains current on changes in coding and billing standards.
• Strives for the optimal payment to which the facility is legally entitled, remembering that it is unethical and illegal to maximize payment by means that contradict regulatory guidelines.
• Consults physicians for clarification and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record.
• Diagnosis coding must be accurate and carried to highest level of specificity.
• Assigns and reports codes that are clearly and consistently supported by documentation in the health record.
• Follow up status of charges held for clearance.
• Work interface error report Pull missing demographic information.
• Maintains PMS up to date with coding and mappings
• Runs exception reports to analyze and address patterns of coding errors.
• Responsible for properly performing month end tasks within the established timeframe including running month end reports for each center assigned and tracking of cases that are not yet billed for the month.
• In cCollaboration with Billing and Managed Care Director and PFS Manager plans, develops and coordinates ongoing training and education for the staff.
• Ensure compliance of UHC policies and procedures.
• Reconciling and ensuring capture of necessary data for reporting and system processes on a monthly basis.
• Reviewing charge and payment posting and coding for accuracy.
• Keeping the Director of Billing and Managed Care updated with any issues which have the potential for a disruption of service, changes in coding.
• Working collaboratively with the Billing and Managed Care Director and PFS Manager to address sectors/managers/supervisors, physicians, and patients.
• Anytime may provide assistance to all level of employees regarding coding issues.
• Other duties as assigned. PERFORMANCE AREA 2: General Corporate Expectations
• Attends and actively participates in all meetings (e.g., department meetings, program meetings, employee staff meetings) and other activities as required or assigned.
• Other work-related duties as assigned by supervisor. Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
• Attends workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.
• Supports the overall needs of the health center by working flexible or extended hours when necessary.
• Demonstrates awareness of, and compliance with, organizational mission and objective of UHC to provide health care access and support services for all members of the community.
• Supports their own staff development by completing the required hours of continuing education each year.
• Maintains confidentiality and respect for information regarding patients and other team members; abides by UHC Rules of Confidentiality and general HIPAA regulations regarding privacy.
• Displays a positive, professional and respectful demeanor at all times toward employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for the health centers.
• Contributes to the team by promoting positive staff interaction, maintains open communication with other programs/departments.
 
QUALIFICATION REQUIREMENTS: EDUCATION:
• AA degree in Business or Health Administration or related field or equivalent years of experience LICENSE/CERTIFICATION:
• Possess a valid Driver's License
• Certified Professional Coder Certification
 
PRIOR EXPERIENCE:
• Two (2) or more years of experience in healthcare setting, preferably in an ambulatory care environment or Federally Qualified Health Center
• Two or more years of experience in clinical coding
• Extensive medical and dental terminology, required SKILLS:
• Knowledge and understanding of the coding process. • Extensive knowledge of ICD-9, ICD-10, CPT, HCPCS, CDT codes
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent verbal and written communication skills including, letters, memos, and emails.
• Excellent attention to detail.
• Ability to research and analyze.
• Ability to work independently with minimal supervision.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proficient use of Microsoft Office applications (Word, Excel, Power Point, Publisher) and internet.
 
PHYSICAL REQUIREMENTS
• Must be able to lift up to 20 pounds and push up to 50 pounds (on wheels).
• Must be able to hear staff on the phone and those who are served in-person, and speak clearly in order to communicate information to patients and staff.
• Must be able to read memos, computer screens, personnel forms and clinical and administrative documents.
• Must have high manual dexterity.
• Must be able to reach above the shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn.
 
Please note this position is posted on behalf of our partner practices. This individual will be working at the specific practice that is mentioned in the above details and will not be a direct employee of Aledade, Inc. so will therefore not be eligible for the benefits available to Aledade employees.  

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Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.