Medical Coder

About the role

WHO WE ARE

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.

JOB SUMMARY

The Coding Coordinator is an integral component of success as it defines and ensures outstanding clinical care for members. The Coding Coordinator will act as a primary coding contact for compliance oversight with a focus on accuracy and potential coding opportunities. The Coding Coordinator will also be responsible for secondary level quality audits.

DUTIES & RESPONSIBILITIES

The Coding Coordinator job description is intended to point out major responsibilities within the role, but it is not limited to these items.

Participate in risk adjustment coding audits including but not limited to vendor bi-directional chart chases, gap closure, and coding completeness.

Play a key role in medical records retrieval; including but not limited to calling provider offices, obtaining medical records from EMR systems, and partnering with market nurses for retrieval.

Participated in secondary level quality audits of vendor’s work for RADV audits and other risk adjustment projects.

Responsible for performing code abstraction and/or coding quality audits of medical records to ensure that the ICD-10-CM codes are appropriately assigned and supported by clinical documentation.

Identifies and tracks areas for documentation improvements and participates in documentation improvement initiatives.

Maintain all coding certifications and requirements and keep up to date on knowledge of ICD-10 codes, CMS documentation requirements, and risk adjustment guidelines.

Meet and maintain coding quality and productivity standards.

Ensure compliance with all federal rules and regulations.

Research and respond to coding questions submitted via the coding inbox.

Other duties and responsibilities as assigned.

EDUCATION AND PROFESSIONAL EXPERIENCE

Associate degree or bachelor’s degree required.

Three (3) or more years’ experience in Medicare Advantage and Commercial coding and risk adjustment

Current coding certification through AAPC or AHIMA

Extensive knowledge of risk adjustment and ICD-10-CM coding guidelines

Extensive knowledge of Medicare Advantage and Commercial HCC models

Proficient in Microsoft Office Products; Word, Excel, PowerPoint

Medical record retrieval experience

Certified Risk Adjustment Coder (CRC) (Preferred)

HHS IVA RADV experience (Preferred)

PROFESSIONAL COMPETENCIES

Strong written and verbal communication skills

Strong attention to detail

Vast knowledge of EMR systems, medical record review and abstraction

Ability to quickly learn and adapt to meet business needs.

Experience working with Risk Adjustment vendors.

Ability to work independently.

Ability to build relationships with office staff, physicians, and market team.

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of NeueHealth, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.