Develops and maintains positive relationships with physicians, providers, and practice managers within the network. Provides high quality service to physicians, providers, and practice managers. Specific responsibilities include, but are not limited to: explaining the plan’s policies and procedures to providers, resolving providers’ complaints and disputes, ensuring compliance with policies and procedures. May provide guidance or expertise to less experienced employees. Typically requires a Bachelor’s degree in a related area with three to five years of experience in physician relations or a managed care setting. Requires knowledge of medical terminology, proven communication and negotiation skills, and experience with various reimbursement methodologies.

Responsibilities :

Responsibility includes assigning ICD-9-CM codes to documentation received from provider offices and entering into electronic management systems. Reviews health management reports and 360 physical exams for coding accuracy, assign codes if missing, and document opportunities when applicable. May travel to provider offices and conduct chart reviews (extracting ICD-9-CM codes from medical records) or assign ICD-9-CM codes to documentation received for comprehensive review. Identifies providers that may need additional education on ICD-9 coding, documentation requirements, or training on Company tools.

Requirements

Qualifications:

2-3 year of coding experience preferred

Excellent computer skills required

Excellent 10 key numeric key pad skills required

Some type of coding certification required, which may include Certified Professional Coder (CPC), Certified Coding Specialist for Providers (CCS-P), Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).

Extensive knowledge of ICD-9-CM, CPT, and CMS coding principles and guidelines.

Familiarity with physician-specific regulations and polices related to documentation and coding.

Proficiency with ICD-9-CM coding and guidelines. Must be detail oriented, self motivated, and have excellent organization skills and maintain required productivity standards.

Maintain required accuracy rating for all activities.

Ability to articulate findings from chart reviews or company coding tools to administrators, providers and office staff

Experience with Medicare Risk Adjustment guidelines.

Prior audit/quality experience.

Prior experiences teaching/training others on correct coding guidelines and/or have the ability to present to large groups of Physicians/Providers.

Microsoft Office expertise including Word, Excel and Power Point

Required to maintain satisfactory IRR rating for coding activities

Preferred Requirements: Bachelor’s degree. Proficiency with DRG