SUMMARY :
Certified Medical Coder role is responsible for reviewing, abstracting, and coding inpatient and / or outpatient medical records to ensure proper ICD-10-CM, HCPCS, and CPT coding and compliance with Risk Adjustment requirements.
EDUCATION :
- High School Diploma or GED required
LICENSES / CERTIFICATIONS :
A certification in one of the following is required :
Certified Professional Coder (CPC)Certified Risk Adjustment Coder (CRC)Certified Coding Specialist (CCS)Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)EXPERIENCE :
Minimum of three (3) years HCC experience performing retrospective risk adjustment chart review requiredMinimum of three (3) years of experience in a hospital, a physician setting, or a Managed Care Organization as a medical coderCurrent AAPC or AHIMA credential requiredRisk Adjustment / HCC knowledge requiredManaged Care experience preferredSKILLS :
Knowledge of healthcare deliveryStrong oral and written communication skillsAbility to work in a fast-paced environment with changing prioritiesAbility to work with others in a matrixed environmentDemonstrated time management and priority setting skillsDemonstrated problem solving skillsDemonstrated organizational skillsRESPONSIBILITIES :
Follows CMS Risk Adjustment guidelines and has a complete understanding of their real-world applicationReviews submitted medical records to identify ICD-10-CM diagnoses, ensuring the documentation meets all CMS standard requirements for valid submissionCodes all diagnoses and services accurately and completely, from the medical record in accordance with the ICD-10-CM coding classification systemSelects and accurately records all appropriate records and data on assigned chart abstraction projectsAbility to meet productivity and accuracy requirementsPerforms other duties as assignedTECHNICAL SKILLS :
Microsoft OfficeElectronic Health Records (EHR)About Apex Health Solutions
Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex’s unique solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex’s experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care.