HCC Coder

Job Objective
To effectively interface with provider partners to successfully monitor and implement an HCC coding strategy. Provide coding expertise as well as administrative oversight to ensure successful integration of PPMC’s HCC initiatives.

Job Responsibilites


Regularly and on a daily basis, exercises independent judgment and uses specialized background, training and experience to assure efficient function of inpatient review and to provide medical information to assist with various reporting requirements, by performing the following tasks with little or no supervision;

 

The role of the HCC Coder/Analyst is to identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories.

 

1. Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.

2. Review medical record information to identify all appropriate coding based on CMS HCC categories.

3. Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.

4. Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.

5. Support and participate in process and quality improvement initiatives.

6. Schedule and perform training activities and maintain records of training.

 

7. Monitor the implementation of Corrective Action Plans as needed, and track implementation as it relates to HCC activities and high risk patients, especially in insuring that those patients have appropriate medical record problem lists and corresponding risk score.

 

8. Coordinate CMS Data Validation activities, including record selection, tracking and submission.

 

9. Maintain a comprehensive tracking and management tool to track all HCC activities and insure that all tasks are completed in a timely manner.

 Correlate activities, processes and HCC results/ metrics to evaluate outcomes.

Minimum Requirements
Education: Minimum of High School Diploma, Bachelor’s Degree preferred

Licensure:  Certified Medical Coder required

Knowledge:  HMO, Commercial, Medi-Cal, Medicare and self-insured health benefit plans.

Experience: Prior coding experience, preferably in a medical office environment