Job Description Job Schedule This role offers a hybrid schedule. You will need to visit two centers twice a week: one day at the Ocoee center and one day at the East Colonial center. These onsite visits are mandatory and non-negotiable. The remaining days of the week will be remote work. Job Summary The Medicare Coder Specialist facilitates modifications to clinical documentation through pre‑visit and post‑visit interaction with providers and other members of the healthcare team. She or he promotes capture of clinical severity (later translated into coded data) to support the level of service rendered to relevant patient populations, enhance evidence‑based medicine, promote continuity of care, and improve capturing chronic conditions. Responsible for coding all medical services procedures CPT and HCPCS codes, pharmaceuticals supplies, patients’ ICD‑10 diagnoses, signs, and symptoms when applicable, ensuring that all assigned ICD‑10‑CM codes are supported by proper clinical documentation. Essential Job Functions Clinically evaluate how the health record translates into coded data, including review of provider and other clinician documentation, lab results, diagnostic information, and treatment plans. Daily review of outpatient medical records during pre‑visit and post‑visit review. Communicate with providers either through discussion or in writing (e.g., formal queries) regarding missing, unclear, or conflicting health record documentation, and clarify the information as warranted. Communicate with appropriate clinical team members to promote accurate and complete documentation of diagnoses and/or procedures in the health record that have direct bearing on plan of care. Gather and analyze information pertinent to documentation findings and outcomes and use this information to develop action plans for process improvement. Confirm that responses have been appropriately documented. Collaborate with HIM/coding professionals to review individual problematic cases and ensure accuracy of final coded data in conjunction with CDI managers, coding managers, and/or physician advisors. Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization. Develop provider education strategies to promote complete and accurate clinical documentation and correct negative trends. Identify patterns, trends, variances, and opportunities to improve documentation review processes. Enhance expertise in query development, presentation, and standards (including an understanding of published query guidelines and practice expectations for compliance). Conduct independent research to promote knowledge of clinical topics, coding guidelines, regulatory policies and trends, and healthcare economics. Support any ongoing program that minimizes any organizational risk in the event of a Risk Adjustment Data Validation (RADV) Audit. Educate providers on HCC Coding and clinical documentation requirements related to Risk Adjustment. Work with suspect and dropped reports. Comply with HIPAA and code of conduct policies. Interact with appropriate resources that support growth and education of the CDI team. Utilize the clinic’s designated clinical documentation system to conduct reviews of the health record and identify opportunities for clarification. Qualifications No supervisory responsibilities. Preferred Background IMG, foreign physician, or RN with two years of outpatient experience in a primary care setting. Required Experience 3‑5 years of experience in Medical Coding (ICD‑10, CPT, HCPCS), Risk Adjustment prospective and retrospective review; and HEDIS/Stars experience. Advanced clinical expertise and extensive knowledge of complex disease processes with broad clinical experience in an outpatient setting. Required Licenses and Certifications Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) Required Knowledge, Skills, and Abilities Strong understanding of ICD‑10‑CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models. Strong understanding of pre‑visit and post‑visit review. Must be able to read, write and speak English. Advanced level of proficiency in MS Office – Excel, PowerPoint, and Word. Ability to defend coding decisions to both internal and external audits. Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines. Must be able to follow policies and procedures. Preferred Qualifications Excellent presentation and analytical skills and must be able to follow procedures. Ability to understand, interpret and abstract data/documentation. Able to work independently and make decisions effectively in a stressful environment. Ability to take initiative and manage different tasks with quick turnaround time. Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC) and Certified Professional Medical Auditor (CPMA). #J-18808-Ljbffr