Certified Coder / Claims Analyst
Position Title: Certified Coder, Claims Analyst
Report To: Billing and Coding Administrator
OSHA: Must adhere to universal precautions, to include blood borne pathogen protection, at all times.
The Certified Coder, Claims Analyst, provides an important function in ensuring all claims for ACO patients are appropriately supported and coded correctly. This individual will be responsible for monitoring medical coding trends, identifying areas of risk and improvement, regularly reporting trends to leadership, communicating clinician training needs to the Certified Coder, Provider Education Specialist, and supporting the Billing Team on effectively managing claims held by Athena. While this position does not have any staff reporting to it, it is expected that the Certified Coder, Claims Analyst, will support the Billing Team and regularly collaborate with the Certified Coder – Provider Education Specialist.
Primary Roles and Responsibilities:
- Audit records to ensure proper submission of services prior to billing on pre-determined selected charges and track errors in the Coding Department folder on the X drive-Coding Department-Audits- Daily Claims Audits – “Name here”.
- Creates spreadsheets to track coding errors and corrections in the Coding Department folder on the X Drive-Coding Department-Audits- Daily Claims Audits- Provider Error Reports-20XX.
- Audit medical records to ensure proper coding is complete and concise as well as to ensure compliance with federal and state regulatory bodies.
- Effectively communicate/correct and apply ICD-10-CM, CPT and HCPCS codes on claims.
- Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.
- Analyzes provider documentation to assure the appropriate, ICD-10-CM, CPT, HCPCs, HEDIS and Evaluation & Management (E&M) codes are assigned using the correct codes.
- In collaboration with the Director of Business Intelligence, capture clinician HEDIS and Quality reporting; develop specific written strategies for the Certified Coder – Provider Education Specialist to address gaps through training. Again, in collaboration with the Director of Business Intelligence, establish baseline measurements and design tracking mechanism. Present findings to the CMO and CQM committee.
- Review claims and charts with chronic conditions for possible errors in coding and the need for any Risk Adjustment corrections and build training based on findings for all responsible staff.
- Set goals for performance and deadlines with Coding and Revenue Cycle staff in ways that comply with company’s plans and vision and communicate them to subordinates.
- Partner in CQM, UR and ACO Meetings for needed expertise.
- May assist with organizational UDS, ACO, MCHS and Perinatal reports.
- Participate monthly Certified Coder team meetings submit recommended agenda items to the Billing and Coding Administrator.
- Perform other related duties as required or assigned by the Billing and Coding Administrator.
Qualifications and Education Requirements
- Associates Degree in management or equivalent experience preferred.
- Four (4) years’ experience using ICD-10-CM, CPT, HCPCs, or its equivalency.
- Medical Coding Certificate – CPC, CCS-P or RHIT certification is required.
- Must have excellent interpersonal skills and is able to communicate effectively.
- Must be proficient in: Microsoft Excel, Word and PowerPoint.
- Must be able to review, and interpret medical records with minimum assistance from providers.
- Must be able to analyze data and report it effectively.
- Must have working knowledge of medical terminology and anatomy.
- Must have knowledge of HCC and Risk Adjustment scoring.
- Must have OB/GYN Coding and Billing knowledge.
- Must be able to communicate and train effectively.
- Must be able to travel to Centers when required.
- Lean Six Sigma Green Belt or Higher preferred
This job description is not intended to be all-inclusive, and the employee will also perform other reasonable related business duties as assigned by supervisor.
- This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.