Medical Coding Compliance Specialist Job Listing at Medical Mutual in OH (Job ID 2400644)

Description

We are seeking candidates that reside in the EST or CST time zones.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million Ohioans through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans.

Medical Mutual' s status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us and help our members achieve their best possible health and quality of life.

Responsibilities

Medical Coding Compliance Specialist I

Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA (Medicare Advantage) with assigning and maintaining diagnoses medical codes.  Evaluates requests for adherence to Company polices for the most precise medical codes.  Audits vendors for quality assurance of risk adjustment coding for ACA and MA.   

·    Conducts initial retrospective chart audit, documents discrepancies, and identifies and suggests accurate coding opportunities based on coding and clinical knowledge.  Codes and rechecks all diagnoses and procedures by applying ICD-CM and CPT-4 codes adhering to all official coding guidelines, federal and state regulations, AHA Coding Clinic determinations, health system and departmental policies, internal coding guidelines, and productivity standards.

·    Supports Risk Adjustment Data Validation (RADV) audits required by CMS for ACA and MA Risk Plans. Assists in preparation and implementation of necessary internal controls for related entities consistent with CMS and State requirements.

·    Attends continuing education classes to maintain coding proficiency and certification requirements. Maintains knowledge of AHA Coding Clinic and ICD-10-CM Official Guidelines for Coding and Reporting.

·    Responds to coding inquiries from various internal departments. Collaborates on and supports various projects where coding expertise is required, such as corporate audits.

·    Performs other duties as assigned.

Medical Coding Compliance Specialist II

Optimizes/reviews documentation for the application of risk adjustment coding for ACA (Affordable Care Act) and MA (Medicare Advantage) with assigning and maintaining diagnoses medical codes.  Evaluates requests for adherence to Company polices for the most precise medical codes.  Audits vendors for quality assurance of risk adjustment coding for ACA and MA.   

·    Conducts initial retrospective chart audit, documents discrepancies, and identifies and suggests accurate coding opportunities based on coding and clinical knowledge.  Codes and rechecks all diagnoses and procedures by applying ICD-CM and CPT-4 codes adhering to all official coding guidelines, federal and state regulations, AHA Coding Clinic determinations, health system and departmental policies, internal coding guidelines, and productivity standards.

·    Performs quality review audit of vendor coding.  Communicates findings to vendor for correction. Maintains departmental tracking logs/databases.  

·    Participates in Risk Adjustment Data Validation (RADV) audits required by CMS for ACA and MA Risk Plans. Assists in preparation and implementation of necessary internal controls for related entities consistent with CMS and State requirements.

·    Delivers audit results to provider/provider office. Communicates findings and works with provider office to educate on coding and documentation improvement opportunities.

·    Serves as a subject matter expert on AHA and ICD-CM coding guidelines for physicians and other patient care team members. Responds to coding inquiries from various internal departments. Collaborates on and supports various projects where coding expertise is required, such as corporate audits.

·    Attends continuing education classes to maintain coding proficiency and certification requirements. Maintains knowledge of AHA Coding Clinic and ICD-10-CM Official Guidelines for Coding and Reporting.

·    Performs other duties as assigned.

Qualifications

Medical Coding Compliance Specialist I

Education and Experience:

·   Bachelor's Degree in Healthcare Administration or related field, or equivalent combination of education/training and experience.

·   1-2 years clinical coding experience using ICD (International Classification of Diseases and Procedures) and CPT (American Medical Association Current Procedural Terminology) coding systems. 

·    Experience in auditing medical records is preferred.

Professional Certification(s):

REQUIRED

·       American Academy of Professional Coders (AAPC)

o   CPC (Certified Professional Coder)

AND/OR

·       American Health Information Management Association (AHIMA)

o   RHIT (Registered Health Information Technician) and/or

o   CCS/CCS-P (Certified Coding Specialist/Physician-based)

·       CRC (Certified Risk Adjustment Coder) or other industry recognized certifications a plus

Technical Skills and Knowledge:

·    Demonstrated proficiency in ICD and CPT coding.

·    Ability to read and interpret medical coding regulations and specifications.

·  Basic knowledge and understanding of hospital and provider operations as it applies to medical coding and documentation processes. 

·    Understanding of Risk Adjustment hierarchical condition categories (HCCs), for all risk adjusted product.

·     Knowledge of Electronic Medical Record systems and system logic

·     Basic to Intermediate proficiency with Microsoft Office (Outlook, Excel Word) and internet navigation for research.

Medical Coding Compliance Specialist II

Education and Experience:

·   Bachelor's Degree in Healthcare Administration or related field, or equivalent combination of education/training and experience.

·   3 years' experience as a Medical Coding Compliance Specialist or equivalent clinical coding experience using ICD (International Classification of Diseases and Procedures) and CPT (American Medical Association Current Procedural Terminology) coding systems. 

·    Experience in auditing medical records is preferred.

Professional Certification(s):

REQUIRED

·       American Academy of Professional Coders (AAPC)

o   CPC (Certified Professional Coder)

AND/OR

·       American Health Information Management Association (AHIMA)

o   RHIT (Registered Health Information Technician) and/or

o   CCS/CCS-P (Certified Coding Specialist/Physician-based)

·       CRC (Certified Risk Adjustment Coder) or other industry recognized certifications a plus

Technical Skills and Knowledge:

·     Demonstrated proficiency in ICD and CPT coding.

·     Ability to read and interpret medical coding regulations and specifications.

·   Extensive knowledge and understanding of hospital and provider operations as it applies to medical coding and documentation processes. 

·     Thorough understanding of Risk Adjustment hierarchical condition categories (HCCs), for all risk adjusted product.

·     In depth knowledge of Electronic Medical Record systems and system logic.

·     Intermediate proficiency with Microsoft Office (Outlook, Excel Word).

·     Proficient in CMS and other web-site research for coding changes and risk adjustment guidance.

·     Ability to defend/educate coding decisions to providers and provider's teams.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.