This position is located in Sunrise, FL.
GENERAL SUMMARY
Responsible for performing audits of medical records to ensure the ICD-9 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the Risk Adjustment Payment System (RAPS) are appropriate; accurate; and supported by written clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
ESSENTIAL RESPONSIBILITIES
- Performs audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical documentation.
- Provides education to internal staff and external providers based on audit findings. Provides general education on ICD-9 codes as appropriate.
- Effectively communicates the audit process and results to the appropriate departments and management.
- Assists senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy can be achieved.
- Remains current on ICD-9 codes; CMS documentation requirements; and State and Federal regulations.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent.
- Previous (2-4 years) experience in medical record documentation review, diagnosis coding, and/or auditing required.
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required.
- Knowledge of ICD-9/CPT codes required.
- Medicare and/or Medicaid Risk Adjustment process experience required.
- Excellent organizational, interpersonal, and communication skills.
- Strong analytical and problem solving skills.
- Ability to use standard corporate software packages and corporate applications.
Job: Administrative Support Workers
Primary Location: Sunrise, FL, US
Organization: 37200 - Coventry Product Services, Inc
Schedule: Full-time
Job Posting: 2012-09-04 00:00:00.0
Job ID: 1211304