[Hiring] Clinical Quality Coder II @Sutter Health

Role Description

This position conducts review of outpatient medical records using International Classification of Disease Coding ICD-10-CM and Current Procedural Terminology (CPT), Medicare Advantage, ICD-10-CM, and Centers for Medicare and Medicaid Services (CMS) coding and reporting guidelines.

• Performs medical record reviews to ensure accurate assignment of medical diagnoses and procedures.
• Responsible for pre-appointment review of each encounter in scope, including Medicare Advantage encounters, to ensure accurate reporting of diagnoses and to alert the physician of potential clinical conditions that may require review.
• This position will support risk adjustment code validation for CMS and HHS Risk Adjustment models.

Qualifications

• HS Diploma or General Education Diploma (GED)
• CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or AAPC Coding Certification (CCS-P, CPC, COC or CPC-P)
• One (1) year of recent relevant experience with CMS-HCC and HHS-HCC risk adjustment coding, including review of pediatric and OB/GYN diagnoses and related documentation requirements.

Requirements

• Advanced knowledge of ICD-10 diagnosis coding conventions and requirements.
• Knowledge of Quality Coding Program requirements such as the Medicare Advantage Coding Program/HCC, as well as medical terminology and abbreviations of disease, illness and injury process.
• Proficient use of grouper software and/or coding reference books to assign/validate diagnosis codes.
• Familiarity with National Correct Coding Initiative edits, Coding Clinic and CPT Assignment coding guidelines and the contents of a medical record.
• Ability to work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions.
• Demonstrated written and verbal communications skills to explain sensitive information clearly and professionally.

Benefits

• Comprehensive benefits package.