Medical Coder / Job Req 788802373 at ALAMEDA ALLIANCE FOR HEALTH in Alameda, California

Job Description:

PRINCIPAL RESPONSIBILITIES:
Under the general supervision of the Manager, IT Applications, the Medical Coder will accurately review and evaluate coding on member claims for the purpose of reimbursement and researches the use of diagnosis (ICD-10) and procedure (CPT/HCPCS) codes for services provided in accordance with Alliance policies and procedures. In addition, the Medical Coder will provide support to the annual HEDIS audit and review encounter data to resolve coding issues. The Medical Coder utilizes advanced knowledge of professional coding to review and recommend changes to systems, policies or procedures to guarantee current and appropriate coding guidelines are maintained and performs other related duties as assigned.
Principal responsibilities include:
Review coding updates for CPT, HCPCS, ICD-10 CM and ICD-10 PCS as published and verify system adherence to new revisions. Review Medi-Cal Provider Bulletins on a monthly basis to determine any impacts to system configuration and claims processing. Utilized advanced, specialized knowledge of medical codes and coding protocol to make sure the organization is following Medicare and Medi-Cal protocol for payment of claims. Monitor updates of various code sets to ensure accurate and timely operations. Responsible for administrative duties related to planning, scheduling and conducting coding audits and maintaining records of providers audit results for CPT/HCPCS and ICD-10 codes. Document results of all coding audits and suggestions for coding and documentation improvement. Retrospectively analyze patient records to determine and assign DRG and ICD-10-CM coding via principal diagnosis, secondary diagnoses and principal procedure sequencing and DRG assignment according to national coding conventions, regulatory agencies and reimbursement practices. Verify and abstract all encounter data from the claim to assign appropriate codes. Correctly code data as appropriate. Participate in provider education on appropriate coding of ICD-10CM coding and CPT/HCPCS coding Review, analyze and assure member claims and provider documents are compliant with current policies. Review claims encounter data to resolve coding edits. Ensure that all data and codes are consistent with ICD-10-CM Official Guidelines, CPT, CMS, OMFS, Medi-Cal, as well as regional and local policies. Maintain up to date knowledge of the current changes in coding practices by continuing education and reading resource material. Maintain and comply with policies and procedures for confidentiality of all member claims.Complete other duties and special projects as assigned.
ESSENTIAL FUNCTIONS OF THE JOB:
Review documentation and data. Identify diagnostic and procedural information. Verify documentation to support diagnoses, procedures, and treatment results. Check codes for reimbursement and compliance with regulatory requirements utilizing guidelines. Follow coding conventions. Identify discrepancies, potential quality of care, and billing issues. Stay abreast of current regulations to maintain certification. Comply with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
PHYSICAL REQUIREMENTS:
Constant and close visual work at desk or computer. Constant sitting and working at desk. Constant data entry using keyboard and/or mouse. Frequent use of telephone headset. Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person. Frequent lifting of folders and various other objects weighing between 0 and 30 lbs. Frequent walking and standing.
Number of Employees Supervised: 0
MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:
Associate degree in related field preferred. Current CCs, CCs-P or CPC Certification by AHIMA or AAPC required.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
Minimum two years of coding experience with an emphasis on Medicare and Medi-Cal requirements in a Managed Care environment. Prior experience in the healthcare field specifically related to coding and/or medical billing and compliance is required. Familiarity with state and federal laws, professional standards and accreditation standards is necessary. Experience with commercial data quality tools (e.g.DRG Grouper) preferred to configure ICD codes, analyze, improve and control data quality.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
Advanced knowledge of ICD-10 CM/PCS and CPT/HCPCS coding, medical terminology and regulatory requirements. Demonstrated ability to understand the clinical contents of a medical record. Knowledge of healthcare reimbursement guidelines, policies and procedures. Knowledge of related laws and regulations. Practical knowledge of government and other payer coding, billing and collection rules and regulations. Excellent verbal and written communications skills. Team player who builds effective working relationships. Ability to work independently. Strong organizational skills. Able to operate PC-based software programs including proficiency in Word, Excel, Outlook, and PowerPoint.
SALARY RANGE $83,241.60 - $124,862.40 Annually

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.