Ambulatory HCC Coding Educator & Regulatory Research Specialist - CaroMont Health

Job Summary: To identify needs for (through auditing or other methods)and provide coding education related to HCC (Hierarchical Category Coding). Serve as a liaison to ambulatory Clinical Documentation Specialists regarding coding guidelines and documentation required to capture HCC’s for Risk Adjustment coding. Train and educate coding staff on HCC coding issues. Work with payer representatives who audit HCC coding for Managed Medicare plans and participate in the sharing of those audits with staff and other departments as needed. Develop new procedures related to HCC coding and assist with implementation of systems that impact coding, such as 3M’s Ambulatory Module Research payer guidelines or regulatory guidelines that impact coding (ICD10 or CPT) and provide education for Ambulatory Coding Department related to those issues, understanding of claim edits, and denials by payers for coding reasons, to help prevent future denials. Promotes teamwork and act as a liaison with coders and other departments such as Central Billing Office, Practice Managers, Physicians, Ambulatory CDI, Compliance, and others as identified, related to HCC coding and/or regulatory/payer guidelines. Serves as backup for coding and abstracting of all types of records as needed. Participates with physician education regarding documentation needs that impact coding processes.



Qualifications: Bachelor degree in healthcare related field with 2 years experience related to coding/auditing; Associate degree in healthcare related field with 4 years experience coding/auditing experience; or high school diploma with 6+ years of coding/auditing experience. Requires at least one of these certifications: RHIA, RHIT, CCS, CCS-P, CCS-H, CPC, or CPMA. Required to have CRC certification (Certified Risk Adjustment Coder) or obtain within 1 year of hire. Knowledge of coding classification systems, including ICD-10-CM, CPT, E&M level of service, and HCPCS nomenclature, and the rules, guidelines, and coding conventions established by the American Medical Association, the Center for Medicare and Medicaid Services (CMS), and the American Hospital Association as the leading organizations that govern coding rules and reporting. Epic experience preferred. Familiarity with medical record documentation requirements and regulatory requirements for record content a plus for this job. Knowledge of performance improvement, teaching/learning principles helpful. Requires excellent written and oral communication skills and excellent organizational skills. Ability to adapt to change and handle multiple tasks in a complex environment. Ability to work independently as well as within a team environment. Applicant should have good computer skills and working knowledge of office applications to create/maintain spreadsheets, databases, and word processing functions. Must be able to maintain the highest level of confidentiality of sensitive information.



EOE AA M/F/Vet/Disability