Landmark Health Medical Coding Specialist-Remote in Massachusetts
This position plays a key role on the Landmark Health team by ensuring the accuracy, integrity, quality and compliance of coded patient data, identifying opportunities for quality improvement and leading market level education and training to providers and other key team members.
Audit, Education and Training Responsibilities:
• Audit both aggregate coded data and individual encounter data to independently determine opportunities for education, training and documentation improvement for both individual providers and market level provider groups.
• Continually evaluate data for compliance with all applicable state and federal guidelines and internal Landmark policies and procedures.
• Participate in weekly market IDT meeting to give input to the team regarding coding and HCC’s for individual patient charts.
• Evaluate individual physician documentation practices to identify areas for improvement in quality and specificity. Initiate both group and one on one training and/or recommendations for additional areas of training.
• Create training modules and materials to be presented during formal education time – Landmark Way.
• Report individual provider and market level coding and documentation status and performance to the Coding Director and market leadership teams.
• Collaborate within the market team with Pod Leaders, General Managers and Regional Medical Directors to formulate appropriate coding and documentation support for individual providers, pods and/or the market region.
• Perform day to day coding on new providers, mentoring and training them until proficiency is achieved. Determine when proficiency is sufficient to transfer provider’s encounters to the Imagine coding team.
• Perform day to day coding on encounters for markets where domestic coding is contractually required.
Coders may not always perform day to day coding responsibilities, but when they do the following will be expectations:
• Concurrent review of assessment data to validate the appropriate clinical ICD and CPT code(s).
• Retrospective review of records and coded data for audit.
• Ensure code best suits the patient’s clinical condition according to coding regulations and patient’s recent medical care, site of that care and procedures.
• Query providers as necessary via written/verbal communications to obtain accurate and complete documentation to facilitate optimal coding.
• Ensure coding is done at the highest appropriate level of specificity supported by the medical documentation and monitor for opportunities to educate providers on documentation required for optimal specificity.
• Provides feedback and suggestions to providers regarding coding accuracy.
• Identifies trends and opportunities for improvement in clinical documentation and reports this information to the Director of Coding.
• Ensures compliance with and adheres strictly to all regulatory coding guidelines including:
o ICD.9 and ICD.10 Official Guidelines for Coding and Reporting
o AHA Coding Clinic for ICD.9 CM and ICD.10 CM
o CMS Medicare Part C instructions and requirements for diagnostic coding.
Coding Credential – at least one of the following: CPC, CCS, CCS-P, RHIT, or RHIA.
1 year outpatient coding experience.
ICD.10 certification through recognized national organization.
Proficiency in ICD.10 coding.
2+ year experience coding ICD.9/ICD.10 for HCC utilization.
Familiarity with Medicare Risk Adjustment.
Experience working with providers for documentation improvement.
We are now part of Optum and the United Health Group family of businesses, backed by the resources of a global health organization working to help people live healthier lives and to help make the health system work better for everyone.
As part of our hiring process, upon accepting an offer, candidates will be required to complete a 9-panel drug test. Due to our partnership with the Medicare Advantage program, our drug testing policies are consistent with Federal law.
Please be aware that Landmark Health does not solicit money or offer payment for job applications, nor do we ask candidates to email or submit any personal information over unsecured channels.
Landmark Health requires all new hires and employees to report their COVID-19 vaccination status.
Job Locations US-MA
Posted Date 2 weeks ago (11/23/2021 10:30 AM)
Type Regular Full-Time
Job ID 2021-6864
Remote Classification Virtual Continuous
- Landmark Health Jobs