Certified Medical Coder

Description

Position Summary: A great opportunity to work with a dynamic all physician Board of Directors and talented management team to support the clinical needs of the fastest growing IPA in the Central Valley serving Fresno and Madera Counties. Under the supervision of the Chief Operating Officer, the Certified Coder is responsible for reviewing medical records for supplemental codes and reviewing findings with medical staff.

The IPA currently has over 13,000 enrollees, 900 providers, and partners with Saint Agnes Medical Center, Madera Community Hospital and Valley Children’s Hospital. In addition to partnering with all the major health plans, MedPRO will be providing all the professional services for the new Central Valley Health Plan through the Department of Managed Health Care, as a restricted Knox Keene Plan.

Medical Coder Duties:

1. Conduct chart audits to review documentation accuracy. Accounts for coding and extracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.

2. Researches and analyzes health plan data needs.

3. Analyzes medical records and identifies documentation deficiencies.

4. Serves as resource and subject matter expert to providers coding and office staff.

5. Follows coding conventions. Serves as coding consultant to care providers.

6. Identifies discrepancies, potential quality of care, and encounter issues.

7. Reviews and verifies documentation supports diagnoses, procedures, and treatment results.

8. Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.

9. Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.

10. Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies and prevent future coding errors.

11. Perform quality assurance activities.

12. Identifies reportable elements, complications, and other procedures.

13. Assists lead or supervisor in orienting, training, and mentoring provider office staff.

14. Works closely with the Medical Director and MedPRO’s management service organization to ensure the submitted data is captured with health plans.

15. Prepare and deliver reports for the Management Team, Governing Board and supporting committees and work groups, such as the Utilization Management and Quality Committee.

16. Interact with contracted Health Plans, their Medical Directors, and associated utilization and quality assurance staff.

17. Handles special projects as requested.

Position Qualifications:

1. Proficient in clinical practice and utilization guidelines, quality assurance measures, HEDIS and Star goals and objectives, with direct communication to provider practices.

2. Skill in providing excellent customer service and support; organize and prioritize workload and meet deadlines; and excellent written and verbal communication.

3. Ability to interact effectively and professionally with persons from diverse cultural, socioeconomic, education, racial, ethnic and professional backgrounds.

4. Ability to work effectively with managers, co-workers, members of the public and professional groups.

5. Ability to communicate effectively, clearly, concisely with others (internal and external customers, both verbally and in writing), consistently demonstrate positive/proactive customer service attitude. Consistently maintain ethical behaviors exemplary of quality public service and fair standards, inclusively, among all employees and members of the public.

6. Ability to work as an effective team member and interact on regular basis with remote employees; function independently, exercise sound judgment and initiative; be flexible to shift priorities; maintain confidentiality; establish and maintain effective interpersonal work relationships, effectively assist providers; work toward goals and objectives of draft priorities.

7. Ability to deliver constructive feedback including evaluation of provider’s documentation and report findings.

8. Other duties as assigned, including but not limited to participation on clinical committees, providing education, Quality Review and/or other activities.

9. Must be computer literate with ability to pull, analyze and compile various clinical reports.

10. Must be able to read, write and speak English. Bilingual is a plus.

Education and/or Experience:

Preference will be given to work experience in a public health or community clinic setting, previous work experience as a certified medical coder with a minimum of two years of related experience, completion of High School diploma, GED, or equivalent.

Must be willing to travel locally on as needed basis.

Primary Location: Fresno CA, service area Fresno and Madera Counties

Job Type: Full Time

Shift Type: Days

Compensation: To be determined

Submit Confidential Letter of Interest and detailed Qualifications to:

Anugeet Aujla

Chief Operating Officer

Central Valley Medical Providers, Inc.

1303 E. Herndon Ave. MS 840

Fresno CA 93720

Or :

Email: anugeet.aujla@cvmedpro.com