Job Description
- Description:
- Perform chart reviews to ensure proper ICD-10, CPT, and HCC coding across professional services.
- Educate providers on documentation standards for E/M leveling, time-based billing, and HCC coding.
- Partner with clinical leadership to improve diagnosis specificity and close coding gaps.
- Ensure alignment between clinical documentation, coding, and claim submission.
- Monitor modifier usage, place-of-service accuracy, and billing edits to reduce denials.
- Review pre-bill and post-bill data to catch errors before claims are submitted.
- Collaborate with the billing team to respond to coding-related denials and payer inquiries.
- Conduct internal audits to measure documentation quality, coding accuracy, and billing compliance.
- Prepare reporting for leadership on trends, risk areas, and financial impact.
- Stay current on CMS guidelines, payer policies, and code set changes; update internal teams accordingly.
- Work closely with the VP of Revenue Cycle, compliance team, providers, and external coders.
- Create and lead training sessions and materials for clinical and billing staff.
- Support risk adjustment and value-based care initiatives with coding expertise and documentation insight.
- Requirements:
- Bachelor’s degree in Health Information Management, Healthcare Administration, or related field preferred
- CPC (Certified Professional Coder) mandatory
- One or more of: CRC, CPMA, CCS-P, RHIT, or RHIA
- 5+ years of experience in medical coding, documentation review, and billing compliance—focused on primary care services and nursing homes
- 3+ years in a senior-level coding or billing position (lead or supervisory role preferred)
- Strong knowledge of risk adjustment (HCC/RAF) and E/M coding
- Strong interpersonal and communication skills, with a proven ability to foster cross-departmental collaboration.
- Benefits:
- 401k with employer match
- Comprehensive health, dental, and vision insurance
- Paid time off (PTO)
- Employer-paid life insurance policy
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