Coding Specialist

Essence Healthcare is a physician owned plan that has been organized to operate as a Medicare Advantage Plan serving the greater St. Louis Metropolitan Area.  Essence offers comprehensive benefits specifically designed to serve aging Medicare patients.  We offer our members a simple way of achieving better healthcare.

 

SUMMARY:

 

The Coding Specialist participates in the development of coding education, physician audits for HCC coding and re-credentialing criteria, responsible for provider and staff education specific to coding related issues, serves as a resource to all markets.  Reviews and edits all HCC materials used in educational sessions. Prepares and analyzes operational data and prepares reports and documents.

 

 

PREFERRED QUALIFICATIONS:

 

Formal training which will be indicated by a Bachelors degree in Health Information Management, (RHIT or RHIA preferred) or 5+ related experience in the field of coding/compliance.  Must have a thorough comprehension of federal and state laws and knowledge of HIPAA, HEDIS, ICD-9, CPT, HCPCS, HCC’s and Electronic Medical Record.

 

 

DEPARTMENT STANDARDS/RESPONSIBILITIES:

 

 

PERFORMS  DEPARTMENT DUTIES IN A TIMELY AND EFFICIENT MANNER.  MAINTAINS THE CONFIDENTIALITY OF PATIENT INFORMATION.

 

1. Embraces Essence philosophy and abides by these values when performing all functions.

2. Code Maintenance

q Checks for updates of ICD-9, CPT and HCPCS codes.

q Educates as required on implementation of use of new codes.

q Works with IS to add new and revised codes into the system.

q Performs coding maintenance functions for the computer system.

q Assists with coding questions as needed.

 

3. Coding Education

q Assists with training of providers on coding and documentation guidelines.

q Conducts weekly review of pertinent websites to research updates.

 

4. Physician Audits

q Conducts physician audits for HCC coding and for re-credentialing.

q Performs focused audits as deemed necessary.

 

5. Monitors Websites and Publications

q NCD’s and LCD’s

q CMS open door forum

q Coding list serves, publications, CodeCorrect and mailing lists.

q HIPAA-OCR, CMS, website, mailing list, listserve, and privately sponsored websites.

q Medicare:  Missouri and Illinois, listserves and publications.

q Federal Register

 

6. Attends all appropriate company meetings.

 

7. Performs other duties as assigned by superiors.