Outpatient Coder

at  Steward Health Care

Position Purpose: This position reports to the Manager of Risk Adjustment Coding for Steward Health Care Network in Needham, MA. As a member of the Risk Adjustment team, the Outpatient Risk Coder works remotely in collaboration with Providers and Practice Staff with opportunities for improved quality, risk adjustment coding performance. The Outpatient Risk Coder is a valuable resource in process improvement and identifying clinically appropriate risk adjusting conditions to capture. Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, at multiple practice locations, with significant attention to detail for completion of both verbal and written external communications.

• Review outpatient medical record information on both a retroactive and prospective basis to identify, assess, monitor and document claims and encounter coding information as it pertains to risk adjustment and quality metrics
• Ensure that the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe
• Assess adequacy of documentation of claims and query outpatient provider claims to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
• Audit provider documentation ICD-10 codes to ensure adherence with CMS Risk Adjustment guidelines
• Ensure that quality gaps are being closed while reviewing the medical records, adding CPT Category II codes to claims when appropriate and making sure quality measure documentation is available to be uploaded back to the payers.
• Participate in departmental and physician network performance improvement initiatives.
• Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security.
• Performs other duties as requested.

EDUCATION:

• Associate degree in healthcare or equivalent work experience.
• Certified Professional Coder (CPC) and Certified Risk Coder (CRC).

YEARS OF EXPERIENCE:

• 2-3 years of experience in outpatient coding preferred.

SPECIALIZED KNOWLEDGE:

• Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements.
• Computer literacy of medical information system, records management software, encoders.
• Advanced knowledge of CPT and ICD-10 coding required.
• Familiarity with HEDIS and quality metrics
• Proficiency in MS office (outlook, excel, word).
• Knowledge of federal and state guidelines on all coding systems and sponsored programs
• Professional interpersonal and organizational skills.
• Attentive to detail and organization with ability to work with strict deadlines.
• Strong interpersonal and communication skills: able to effectuate areas of opportunity to providers and practices as well as leadership.
• Strong sense of diplomacy and ability to work under pressure.

• Review outpatient medical record information on both a retroactive and prospective basis to identify, assess, monitor and document claims and encounter coding information as it pertains to risk adjustment and quality metrics
• Ensure that the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe
• Assess adequacy of documentation of claims and query outpatient provider claims to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
• Audit provider documentation ICD-10 codes to ensure adherence with CMS Risk Adjustment guidelines
• Ensure that quality gaps are being closed while reviewing the medical records, adding CPT Category II codes to claims when appropriate and making sure quality measure documentation is available to be uploaded back to the payers.
• Participate in departmental and physician network performance improvement initiatives.
• Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security.
• Performs other duties as requested