Medical Care at Home Coding Specialist- remote
- VNS Health
- Remote
- $62,400 - $72,000 yearly
Job Description
- Reviews medical claims, records and other requested information for billing, coding and other compliance or reimbursement related issues; makes coding and documentation recommendations for adherence to risk adjustment models.
- Reviews medical documentation to ensure all key quality metrics are noted on claim, as provided during the encounter. Performs medical chart reviews to validate codes for quality monitoring, reporting, and analysis.
- Conducts coding reviews independently on all provider documentation to assign the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology.
- Assigns appropriate ICD10-CD, HCPCS and CPT codes as well as other codes necessary to process claims based on claim information submitted.
- Utilizes administrative policies, regulatory codes, legislative directives, and guidelines to inform decisions and appropriate coding.
- Maintains coding grids for MCAH services with the assistance of management and provides guidance on use of grids.
- Works with Clinical Director in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
- Engages with medical practitioners to provide feedback and educational resources on best practices for medical coding and keeps current on new coding and billing guidelines, federal and state initiatives regarding claims and trains other staff in new/changes to regulations. Communicates and follows up with a variety of internal and external sources including but not limited to providers, members, attorneys, regulatory agencies and other carriers on any claim related matters.
- Generates routine reports for managing process time frames and vendor productivity.
- Performs insurance eligibility checks and authorization prior to for care being provided. Communicates with clinicians as needed.
- Coordinates recoupment efforts with the Practice Manager and Revenue Cycle and Finance Departments that are the result of billing errors. Responds to inquiries regarding recoupment.
- Review coding disputes, which includes review of all supporting documentation. Recommend payment based on review and prepare response to appeal.
- Participates in special projects and performs other duties as assigned.
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or (CRC) Certified Risk Adjustment Coder in ICD-10-CM coding required. required Active Certified Coder Certification through AHIMA or AAPC required
Required Experience Level
Minimum Education
Applicant Location
VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 125 years, our commitment to health and well-being is what drives us—we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.