Job Description Gulf Coast MRA Coder
THIS IS NOT A REMOTE CODING POSITION, THIS IS LOCATED IN NORTH FORT MYERS
This position is responsible for ongoing Medicare Risk Scoring improvement activities and reports to a Medicare Risk Adjustment (MRA) Management Leader. This position includes ongoing quality improvement activities to assure the organization's MRA programs are implemented and meet all requirements.
Essential Duties and Responsibilitiesinclude the following. Other duties may be assigned.
- Coordinates and performs medical record reviews of Gulf Coast Medical records to determine maximizing revenue thru appropriate coding and billing and compliance with Medicare Risk Adjustment metrics;
- Creates and distributes HCC code suggestions through use of the Light Beam face sheet or other similar process
- Support continuum of patient care by identifying patients with gaps in care or in need of MRA metrics reporting
- Facilitates education and/or educates providers and office staff on proper CMS Risk Adjustment coding and billing, pay for performance measurements and medical record review criteria;
- Document and trend findings in identified database;
- Generally, works independently, under the supervision of a Medicare Risk Adjustment leader;
- Communicates to the MRA Leader and I.T. Department regarding defects in the reporting system or database, tracks through to completion.
- Creates, maintains, organizes educational tools as related to CMS Risk Coding as needed;
- Performs chart reviews and submissions of supplemental carrier attestations as supported by the medical record as determined by MRA Management Leader.
Education and/or Experience
Associate's degree or equivalent from two-year college or technical school.1 years clinical and/or Medicare Risk Adjustment experience.
1 years of quality improvement experience, or other relevant experience preferred.Experience working in health care and insurance Industry.Knowledge base of clinical standards of care, preventive health standards and Medicare Risk Coding.Ability to travel to physician offices as required; valid state-specific driver's license and reliable vehicle.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
To perform this job successfully, an individual should have proficient knowledge of Microsoft Excel Spreadsheet software; Microsoft Word Processing software, Outlook and ADP Payroll systems. Knowledge of Computers, Fax, Portals, Uploading, Downloading, Athena or other Electronic Medical Record System.
Certificates, Licenses, Registrations
Certified Coder; CPC, CCS-P, CCS-H, RHIT
Physical DemandsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance and talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Work EnvironmentThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.The noise level in the work environment is usually moderate depending on business activity of the office.0