SUMMARY:

Certified Medical Coder role is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10-CM, HCPCS, and CPT coding and compliance with Risk Adjustment requirements.

EDUCATION:

·       High School Diploma or GED required

LICENSES/CERTIFICATIONS:

A certification in one of the following is required:

·       Certified Professional Coder (CPC)

·       Certified Risk Adjustment Coder (CRC)

·       Certified Coding Specialist (CCS)

·       Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA)

EXPERIENCE:

·       Minimum of three (3) years HCC experience performing retrospective risk adjustment chart review required

·       Minimum of three (3) years of experience in a hospital, a physician setting, or a Managed Care Organization as a medical coder

·       Current AAPC or AHIMA credential required

·       Risk Adjustment / HCC knowledge required

·       Managed Care experience preferred

SKILLS:

·       Knowledge of healthcare delivery

·       Strong oral and written communication skills

·       Ability to work in a fast-paced environment with changing priorities

·       Ability to work with others in a matrixed environment

·       Demonstrated time management and priority setting skills

·       Demonstrated problem solving skills

·       Demonstrated organizational skills

RESPONSIBILITIES:

·       Follows CMS Risk Adjustment guidelines and has a complete understanding of their real-world application

·       Reviews submitted medical records to identify ICD-10-CM diagnoses, ensuring the documentation meets all CMS standard requirements for valid submission

·       Codes all diagnoses and services accurately and completely, from the medical record in accordance with the ICD-10-CM coding classification system

·       Selects and accurately records all appropriate records and data on assigned chart abstraction projects

·       Ability to meet productivity and accuracy requirements

·       Performs other duties as assigned

TECHNICAL SKILLS:

·       Microsoft Office

·       Electronic Health Records (EHR)

About Apex Health Solutions

Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex’s unique solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex’s experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care.