Coding Specialist- Certified Coder (CPC)

Monarch HealthCare, the leader in managed health care, located in Irvine, CA, is currently searching for a Certified Coder (CPC). Monarch HealthCare not only offers the most competitive compensation package in the industry, but a great working environment that includes great team members! To apply for this exciting opportunity  please send a current resume to mailto:resume@mhealth.com?subject=Medical%20Claims%20Examiner or apply online.

 

SUMMARY:  The qualified candidate will visit physicians’ offices to conduct chart audits to support CMS-HCC risk adjustment projects.  The Coding Specialist will interface with physicians and their staff in order to develop collaborative, productive relationships.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Other duties may be assigned.

1.  Reviews and analyzes patient medical records in providers’ offices. Ensures the records have been appropriately ICD-9 coded to the highest level of specificity in the CMS-HCC Risk Adjustment model. 

2.  Documents results of the coding audits and makes suggestions for coding and documentation improvement (assessment reports).  Presents the findings to Risk Adjustment Manager, physicians, and other internal/external departments.

3.  Creates positive relationships between physicians and Monarch HealthCare by assisting physicians with variety of questions regarding risk adjustment.

4.  Educates physicians, office staff, and billers on CMS-HCC risk adjustment and Monarch HealthCare’s risk adjustment projects and initiatives.

5.  Trains physicians on how to utilize available reports and tools to improve their risk adjustment knowledge as well as coding skills. 

6.  Assists Risk Adjustment Manager in building effective Risk Adjustment Team by helping junior-level coding specialist with questions and coaching them about Monarch’s specific projects.

7.  Participates in developing, implementing, and reviewing:

·   Programs for coding compliance monitoring,

·   Criteria for benchmark comparisons,

·   Organization’s policies and procedures,

·   Physician clinical documentation improvement programs,

·   Reports and applications supporting Risk Adjustment program  

8.  Maintains records of offices audited, results and additional diagnosis codes identified.

9.  Responsible for administrative duties related to planning, scheduling, and conducting coding audits with physicians.

10. Assists internal and external departments with billing and coding questions as well as risk adjustment related questions.

11. Position is typical 50% in the office and 50% in the field conducting audits.

12. Additional special projects as needed. 

 

 

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

EDUCATION and/or EXPERIENCE:

Coding certification (CPP or CPC through AHIMA/AAPC) is required. 

ICD-9 coding experience/proficiency.

CPT/HCPCS coding experience/proficiency.

Minimum of 3 years healthcare or insurance experience.

Medical Record Review Experience.

 

LANGUAGE SKILLS:

Ability to read and analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.

Ability to write reports, business correspondence, and procedure manuals.

Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Bilingual/Spanish helpful.

 

MATHEMATICAL SKILLS:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

 

REASONING ABILITY:

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.

 

OTHER SKILLS AND ABILITIES:

Must have dependable transportation.

Must possess and maintain a valid California Driver’s License.

Typing skills and Strong Computer Skills including MS Office.

Strong Presentation and Relationship-Building Skills (be able to speak in front of large groups; audience can range from 1 to 150 individuals).

Must be highly organized and detail-oriented.