Provider Network Operations Certified Professional Coder

Provider Network Operations Consultant
There is more than one opening. There are openings in the following cities: Canton, OH, Atlanta, GA, Cary, NC, Hampton,VA, Greenville, SC

Assignment Summary

Assesses and monitors the documentation and coding data submitted on claim/encounters for Medicare Risk Adjustment. Verify and ensure the accuracy and appropriateness of the submitted diagnosis data based on services rendered. This role will include training and serving as a resource on coding procedures and appropriateness to providers, provider office staff, other MRA team members, and other corporate/market departments. Provides exemplary service to ensure long term success in a rapidly changing health care environment.
Review and handle a high volume of claims/encounter data based on the MRA reports.
Assist with verifying the accuracy of diagnosis information submitted on claims/encounters for the purposes of risk adjustment.
Demonstrates problem-solving ability in analyzing and identifying issues or problems with submitted diagnosis codes to actual services provided to the patient.
Validate/invalidate suspect conditions identified.
Evaluate and make recommendations regarding office work flow with coding, superbills, etc.
Provide data, assistance and act as a resource to the Medicare Risk Adjustment team, external business partners, other markets, and internal associates.
Directs applicable issues and questions to the appropriate level and area within the department.
Ensures accurate data entry into applicable systems and/or databases.
Develop audit tools and conduct reviews at the providers’ offices, within our designated 11 state service area, to access the quality of encounter coding. Develop quality improvement plans for outliers as appropriate.
Identify, prioritize, and provide training and serve as a resource on coding procedures and appropriateness to providers, provider office staff, other team members, and other corporate/market associates.
Supports and participates in process and quality improvement initiatives. Consistently recognize opportunities, communicate them to the appropriate parties, that will eliminate barriers and non-value added activities to improve the overall work system in examining patient care data.


Key Competencies
Builds Trust: You honor your word by doing what you say you are going to do.
Champions the Customer: You keep closely attuned to the needs and perspectives of customers and use this insight for the benefit of the business.
Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.
Drives for excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
REQUIREMENTS
Role Desirables
Skilled in ICD-9-CM medical coding preferred
One to three years coding experience preferred
Knowledge of appropriate levels of care and the health care industry
Previous managed care experience

Role Essentials

Must be a Certified Coding Professional (CCP, CPC, CPS)
Effective written and verbal communication skills Analytical and organizational skills
Team building skills
Time management skills
Ability to travel within the designated service area