高级专员，编码 - 图表审计/心理健康 - 远程
Senior Specialist, Coding - Chart Audit/Behavioral Health - Remote
职位描述
职位概述
为编码活动提供高级别的支持。监督对Molina合规计划的遵守情况，降低与编码和计费实践相关的风险，并保护公司免受欺诈/滥用行为相关的责任。执行病历审查，促进医生教育，并保持对编码规则和法规的全面了解。
主要工作职责
- 执行持续的病历审查并提取诊断代码。
- 利用对当前供应商计费实践的理解，确保诊断和现行操作术语（CPT）代码准确提交。
- 与临床信息学团队协调系统错误，并提出改进建议以确保遵循有效的流程。
- 进行编码审查和审计，以确保准确性和合规性。
- 研究并解决编码差异。
- 调查并解决被拒或被退的索赔或就诊记录。
- 保持对电子病历系统（EMR）的熟练程度。
- 记录病历审查的结果/发现，并向管理层、医生和办公室员工提供反馈。
- 创建必要的工具（如教育材料、通讯等），帮助医生实现当前和准确的编码实践。
- 为供应商网络提供风险调整最佳实践的培训和教育，并提供与风险调整相关的编码更新。
- 监督供应商的进展，确保遵循美国医疗保险和医疗补助服务中心（CMS）制定的指南。
- 与供应商建立积极的关系，并在需要时提供编码支持。
- 负责行政职责，如计划、安排病历审查、获取医疗记录以及供应商的培训和教育。
- 与跨职能团队合作，支持各种项目，如风险调整应用的实施、报告开发等。
- 与财务、收入分析、索赔、就诊记录和医学主管等部门协调相关活动。
- 协调CMS数据验证活动，包括记录选择、跟踪和提交，与编码领导合作进行。
- 保持专业和技术相关的编码知识。
- 保持对权威医学编码组织发布的最新编码指导的了解。
- 为新老编码团队成员提供培训和支持。
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JOB DESCRIPTION
Job Summary
Provides senior level support for coding activities. Monitors adherence to Molina's compliance program, minimizing risks related to coding and billing practices, and protecting the business from liability related to fraudulent/abusive practices. Performs chart reviews, facilitates physician education, and maintains comprehensive knowledge of coding rules and regulations.
Essential Job Duties
- Performs ongoing chart reviews and abstracts diagnosis codes.
- Leverages understanding of current provider billing practices to ensure that diagnosis and Current Procedural Terminology (CPT) codes are submitted accurately.
- Coordinates with clinical informatics on system errors and suggests improvements to ensure effective and efficient processes are followed.
- Conducts coding reviews and audits to ensure accuracy and compliance.
- Researches and resolves coding discrepancies.
- Investigates and resolves rejected or denied claims or encounters.
- Maintains proficiency in EMR systems.
- Documents results/findings from chart reviews and provides feedback to leadership, providers, and office staff.
- Creates necessary tools (educational materials, newsletters, etc.) for providers to assist in current and accurate coding practices.
- Provides training and education to network of providers on risk adjustment best practices and provides coding updates related to risk adjustment.
- Monitors progress of providers to ensure guidelines set forth by Centers for Medicare and Medicaid Services (CMS) are adhered to.
- Builds positive relationships between providers and provides coding assistance as needed.
- Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education.
- Collaborates with cross-functional teams to support a variety of projects such as implementation of risk adjustment applications, development of reports, etc.
- Coordinates related activities with departments including finance, revenue analytics, claims, encounters, and medical directors.
- Coordinates CMS data validation activities, including record selection, tracking and submission, in conjunction with coding leadership.
- Maintains professional and technical coding-related knowledge.
- Maintains knowledge of updated coding guidance from recognized medical coding organizations.
- Provides training and support to new and existing coding team members.
Required Job Qualifications
- At least 4 years of medical coding, auditing, and/or compliance experience, or equivalent combination of relevant education and experience.
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
- Detail-oriented skilled in medical/clinical documentation review.
- Ability to collaborate in a cross-functional highly matrixed organization.
- Ability to develop feedback and training tools.
- Ability to present educational materials to relevant groups.
- Effective verbal and written communication skills, including ability to present to medical professionals.
- Microsoft Office suite and applicable software program(s) proficiency.
Preferred Job Qualifications
• Familiar with the Hierarchical Condition Categories (HCC) risk adjustment model.
• Background in supporting risk adjustment management activities and clinical informatics.
To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Originally posted on Himalayas