PreVisit Planning Coder - Summit Medical Group

Description Summit Medical Group is seeking a PreVisit Planning Coder to join their team. This is a f ull-time opportunity in the KNOXVILLE, TN area due to onsite requirements. Examples of Duties (List does not include all duties assigned) Medical Records review and abstractions for the assessment of HEDIS and CMS STARS quality measures and communications to improve compliance. With use of specified reports, HCC database, Athena EHR, hospital portals, member summaries and Group Management, review all records, progress notes and diagnosis for accuracy and completeness of documentation to support ICD coding to the highest level of specificity. Through record review prior to scheduled appointments, accurately identify conditions not yet incorporated in Active Problem List, gaps in preventive services and support code transitions for greater specificity and accuracy. Ensure coding and documentation criteria, rules and guidelines are met. Ensure effective, necessary tasking and communication through Athena via approved task note forms. Through medical record reviews, identify and assist the provider to update the Active Problem List for accuracy (highest degree of specificity) by transitioning the less/unspecified diagnoses codes to the most accurate diagnosis and appropriate code specificity in Athena. Through medical record, progress note and CPT reviews, identify and report trends for educational opportunities in documentation and coding. Maintain continuous, effective, positive, and appropriate communication with a focus on actionable elements. Actively participate in Summit provided seminars for continuing education and remain up to date on rules and changes regarding coding and documentation from appropriate, credible sources. Independently seek CEUs as indicated to maintain Credentials with the AAPC/AHIMA. Appropriately interact with Summit billing and compliance teams regarding proper coding and documentation requirements and processes. Present applicable questions, suggestions and/or information in a timely manner as appropriate and maintain awareness and understanding of internal processes. Serve as a helpful, reliable resource for the sites and providers by continuously looking for ways to improve knowledge, processes, and communications. Build appropriate lasting relationships to reduce risk and support providers. Process Comprehensive Medical Chart reviews for abstraction of ICD-10 codes and accuracy of diagnosis with focused attention on Risk Adjustment HCC coding. Accurately and effectively communicate with the provider with specific information about conditions documented in medical record but not yet incorporated into Active Problem List. Analyze progress notes to identify and/or assign accurate ICD-10-CM codes and appropriate level of service CPT codes in accordance with guidelines and procedures to ensure corporate and regulatory compliance with avoidance of errors and inaccuracies. Actively participate in designated meetings and/or workshops, special projects and other activities associated with the Risk Adjustment program as needed. Continuous use and awareness of ethical coding, the official coding rules, regulations, and coding conventions of the American Hospital Association (Coding Clinic), ICD-9/ICD-10-CM, Centers for Medicare, and Medicaid Services (CMS), and organizational/institutional coding guidelines. Actively participates in site-level Quality Improvement Activities. Each employee will contribute to the continual evaluation site performance as well as the implementation and measurement of improvement activities that increase the quality of care provided to patients. Education Associates degree, bachelors preferred with completion of college/accreditation level coursework in ICD-9-CM, ICD-10-CM and CPT coding, anatomy and physiology, and medical terminology. Experience Minimum Requirements: Must hold a current credential for one of the following: RHIA, RHIT CCS, CCS-P, CPC, CPC-H, and/or CRC. If not CRC certified, you must attain the certification within the first year of your employment date. AHIMA/AAPC Certified Professional: Certification must be maintained by fulfilling the continuing education requirements and submitting current proof. Must have proficient computer skills. The ability to interpret, analyze and abstract data/documentation. Possess good problem-solving skills. Be self-motivated, independent thinker with time management and organizational skills. Review medical record information to identify all appropriate coding based on CMS HCC Categories in accordance with CMS RADV. Preferred Requirements: Two to five years’ experience, coding and demonstrating knowledge in the principals and practices of ICD-10 and CPT code conventions. Certification as a RHIA, RHIT, CRC, CHDA, CCDIS (others may be considered) Risk adjustment, HCC coding experience, awareness and/or demonstrated knowledge. Experienced with CMS Medicare Advantage Risk Adjustment Data Validation Prior medical chart auditing and quality reporting experience Managed care experience Experience with health plan Risk Adjustment processes and systems for CMS RAF assignment and acceptance helpful Clinical experience beneficial. Certification/License Must hold a current credential for one of the following: RHIA, RHIT CCS, CCS-P, CPC, CPC-H, and/or CRC. If not CRC certified, you must attain the certification within the first year of your employment date. AHIMA/AAPC Certified Professional: Certification must be maintained by fulfilling the continuing education requirements and submitting current proof.