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Medical Records Documentation and Coding Review Specialist

Company: Rancho Health MSO, Inc.
Location: Temecula
Posted on: January 26, 2023

Job Description:

Job Summary
Rancho Health MSO, Inc., is seeking an experienced Medical Record Documentation and Coding Review Specialist to become a part of our team. You will focus on conducting quality assurance reviews on internal professional coders and providers, including physicians and advanced practice providers. This will include ongoing audits and training of coders and providers.
This position is responsible for completing quality assurance reviews on internal professional coders and providers, including physicians and advanced practice providers (APPs). This will include ongoing audits and training of coders and providers. This position will also ensure codes are being accurately abstracted and captured in the electronic medical records and ensure that regulatory guidelines are followed by correct usage and interpretation of the official ICD-10-CM, CPT, and HCPCS Guidelines for Coding, AMA CPT Guidelines, Evaluation and Management Guidelines, HCC's and CMMS directives. This position plays a key role in reporting quality results and tracking educational opportunities for optimized clinical documentation. They will also provide education and subject matter expertise to coders and/or providers throughout the company and will be expected to mentor and train the company's coders.
Coding: Will be responsible for coding and auditing medical charts through the understanding of medical terminology, AMA guidelines, anatomy, physiology and procedures and assigning the appropriate CPT, and ICD- 10 CM and special access codes based on medical documentation. They will associate the diagnosis codes to the appropriate procedure codes (CPT) and sequence the codes accordingly to ensure proper reimbursement. They are expected to support the company's consistent coding auditing accuracy rate of 95% or better while also meeting productivity standards.
Billing and Denials: Lead coding and billing staff in managing coding and claim editing work queues. Identify opportunities to reduce coding edits and improve coding accuracy.
Communicate quality issues to management as appropriate. Notify management when there is a compliance concern or incident. Provide support on coding denials. Ensure that coding edits (held accounts) are resolved timely. Be a resource on payor documentation and coding requirements.
Audits and Education: Provide support with physician documentation and education. Develops an organized Audit Program for the MSO. This includes conducting regular audits for pre and post AR audits. Creates physician and coder education from audit opportunities.
Essential Functions:


  • Sitting, talking, hearing and near vision are required over 90% of the time, while walking is required frequently throughout the day.
  • Standing is required over 10% of the time.
  • Feeling is required 90% of the time and reaching is required about 50% of the time.
  • Bending, twisting, and climbing are required, as in far vision, but only for 10% or less of the time.
  • Low levels of lifting (10 pounds of less) are required about 25% of the time, while medium levels (20 to 40 pounds) of lifting and carrying are required less than 5% of the time.

    Required education and experience:

    • Will have an approved AHIMA or AAPC coding credential
    • Must have a minimum of 5 years coding experience
    • Must have a minimum of 2 years coding auditing experience
    • Must have up to date knowledge of CMMS and third-party rules and regulations
    • Will have knowledge of HCC value-based care clinical documentation guidelines
    • EPIC and Athena experience preferred
    • Must maintain current coding credentials

      Minimum Knowledge and Skills Required:

      • Demonstrates strong collaboration skills
      • Exhibits excellent teaching and training skills
      • Has strong analytic and problem-solving abilities and techniques
      • Exhibits consistent initiative with ability to self-motivate and self-direct
      • Demonstrates commitment to a team environment
      • Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail
      • Possess strong time management and organizational skills
      • Commitment and adherence to company Core Values
      • Strong focus on compliance and superior work ethic

        Work Environment:

        • This job operates in a professional office or clinic environment with prolonged periods of sitting and/or standing at a desk and working on a computer.

          Travel:

          • Ability to travel to field sites may be required 10-25% of the time.

            Work Authorization:

            • Must be authorized to work in the United States.
              PI202070410

Keywords: Rancho Health MSO, Inc., Corona , Medical Records Documentation and Coding Review Specialist, Other , Temecula, California

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