Medical Coder (No Experience)  

Clinical Readers are responsible for applying clinical and/or medical coding knowledge in the review of evidentiary documentation in medical records. This position requires the ability to perform and complete diagnostic coding, abstraction of pharmaceutical studies, HEDIS medical records review and other related duties in a high quality and productive environment.

SUMMARY OF DUTIES & RESPONSIBILITIES

Clinical Abstraction assignments may include work from all lines of Company business (e.g., diagnostic auditing, HEDIS review, drug safety/efficacy studies). Each assignment will have specific requirements and time-lines.

• Diagnostic Coding: Clinical Readers review assigned medical records and apply appropriate diagnostic codes and modifiers according to Generally Accepted Medical Coding Guidelines, ICD-10-CM Guidelines and CMS Correct Coding Initiatives, coding guidelines approved by CMS, and all rules, regulations and guidelines promulgated by CMS and applicable to contractors and subcontractors of CMS-approved sponsors (collectively “Standards”), all as reasonably interpreted by the Company.
• HEDIS Reviews: Clinical Readers review assigned medical records and document measure specific clinical data according to NCQA technical specifications for hybrid medical records reviews.
• Health Outcomes Studies: Clinical Readers review assigned medical records and document relevant clinical data according to stated study objectives.
• Other specific details of the job will be made known to the employee by their immediate supervisor which may be in varying scope dependently on prevailing project undertakings.

• Active PRC Registered Nurse license, required
• At least 12 months clinical experience, required
• ICD-9-CM/ICD-10-CM/HCPCS/PCS coding experience, preferred

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES

• Exemplary attention to detail and completeness - must maintain a minimum QA score of 95% or higher across all projects.
• Excellent knowledge of medical records.
• Extensive knowledge of ICD-9-CM outpatient diagnosis coding guidelines.
• Ability to code using an ICD-9-CM/ICD-10-CM code book (without using an encoder).
• Strong clinical skills related to chronic illness diagnosis, treatment and management.
• Ability to decipher difficult-to-read handwriting.
• Detail-oriented in all aspects of work.
• Excellent interpersonal, written and verbal communication skills.
• Strong organizational ability to manage projects with tight timelines.
• Ability to move from project to project with little to no additional training (after initial orientation to project).
• Reliability and a commitment to meeting tight deadlines
• Proficient phone and computer skills, including MS Windows, MS Office, email and internet. Ability to learn additional applications as necessary.
• Strong team player willing to take on additional projects and duties as necessary.
• Demonstrates strong leadership skills.