Professional Coder

Summary:

This position is accountable for accurately reviewing, interpreting, auditing, coding and analyzing medical record documentation for diagnosis accuracy, correct documentation, and Hierarchical Coding Condition (HCC) abstraction. Review may include inpatient, outpatient treatment and/or professional medical services, according to ICD-9/ICD-10 CM coding guidelines and risk adjustment model regulations. This position supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV) along with the annual Risk Adjustment life cycle for the Medicare, Medicaid, and Commercial lines of business.

Responsibilities:

• Can understand and translate CPT, HCPC, ICD-9/ICD-10 codes for HCC abstraction.
• Review medical records for completeness, accuracy and compliance with applicable coding guidelines and regulations.
• Identify, compile and code member/patient data, using ICD-9/ICD 10-CM and other standard classification coding systems.
• Support the collection and distribution of documentation and coding improvement tools for designated practice units as applicable.
• Support educational activities for internal stakeholders as necessary as subject matter expert on coding review/guidelines.
• Actively participate & engage in program improvement discussions and activities.
• Maintains department productivity and accuracy standards.

Qualifications:

• Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist, P from the American Health Information Management (AHIMA).
• Requires 2 - 5 years of Medical Coding experience.
• Requires a minimum of 2 years’ experience in Health Insurance/quality chart audits and/or Utilization Review.
• Bachelor's degree preferred.

Knowledge:

• Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding.
• Requires knowledge of medical terminology of medical procedures, abbreviations, and terms.
• Requires knowledge of the health care delivery system.

Skills and Abilities:

• Requires the ability to utilize a personal computer and applicable software (e.g. proficiency in Word and Excel).
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
• Must demonstrate professional and ethical business practices, adherence to company standards and a commitment to personal and professional development.
• Proven ability to exercise sound judgment and problem-solving skills.
• Proven ability to ask probing questions and obtain thorough and relevant information.

Since 1995, iTech Solutions Inc., has been providing IT Consulting and Direct Hire Services to the Insurance, Financial, Communications, Manufacturing and Government sectors with local offices in Connecticut, Minnesota, Colorado, Massachusetts, Tennessee, North Carolina, and New Jersey / Pennsylvania area.

Our recruiting strategy is simple, if you want to find qualified IT professionals then use IT professionals to find them. So at iTech Solutions, our personnel are all career IT professionals with a wide range of IT experience. We can honestly say our staff understands the technologies, the complexities of finding and selecting the appropriate personnel and the pressures of running successful IT projects.

Employer will not sponsor applicants for any employment visas, at hiring or in the future, including but not limited to H-1B visas. Corp-to-Corp or subcontract personnel will not be considered for this position.

iTech Solutions, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.