QA RAPS Coder

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Southfield, USA

Advantasure

<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p> https://advantasure.com/

keywords: job description,review,compliance,education & experience,knowledge,skills

Non-Manager

Competitive Compensation and Benefits Package

Overview: <br />QA Coder&nbsp;will assist in conducting quality assurance audits for certified coders working in the organization. QA coders will conduct audits to validate codes prior to submission to clients and perform weekly/monthly audits on certified coders as part of quality assurance program.&nbsp;<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards. Requires transporting, pushing, pulling, and maneuvering items weighing up to 25 pounds.</p>
Responsibilities: <br /> <ul> <li>Ensures compliance with all applicable Federal laws and regulations related to coding and documentation guidelines for Risk Adjustment.</li> <li>Ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that applicable to Medicare Risk Adjustment reimbursement initiatives by Certified Medical Coder</li> <li>Reviews medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to validate:&nbsp;</li> <li>The diagnosis codes are supported by the documentation and ensure with ICD-10CM guidelines for Coding and Reporting.</li> <li>The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe.</li> </ul> <br /> <p>This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.</p>
Requirements: <br /> <p><strong>EDUCATION:<br /><br /></strong></p> <ul> <li>Associate degree in a related field preferred.&nbsp;</li> <li>Successful completion of a coding license or certificates; CPC, CPC-H from AAPC or CCS-P, CCS from AHIMA.&nbsp;</li> <li>Relevant combination of education and experience may be considered in lieu of degree.&nbsp;</li> </ul> <br /> <p><strong>EXPERIENCE:<br /><br /></strong></p> <ul> <li>Minimum of one (1) year general coding experience.</li> <li>Experience and understanding of CMS HCC Risk Adjustment coding and data validation requirements preferred</li> </ul> <br /> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:<br /><br /></strong></p> <ul> <li>Excellent organization and problem-solving skills.</li> <li>Strong oral and written communication skills.</li> <li>Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology, and concepts of disease processes.</li> <li>Extensive knowledge of ICD-10CM coding guidelines.</li> <li>Advanced technical skills for use of MS Office (Excel, Word, Outlook, and PowerPoint) as demonstrated through successful completion of a skills test.</li> <li>Demonstrated ability to utilize a variety of electronic medical records systems.</li> <li>Ability to manage a significant workload, and to work efficiently under pressure, while meeting established deadlines with minimal supervision.</li> <li>Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization.</li> <li>Strong time management skills.</li> <li>Must possess a high degree of accuracy, efficiency, and dependability.</li> <li>Excellent written and oral communication for representation of clear and concise results.</li> </ul> <br /><br /> <p>The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.&nbsp;</p> <p>We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.</p>