Medical Coder PACE

About Us
Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.

As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 90k people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.

ROLE OVERVIEW and PURPOSE

The PACE Medical Coder plays a vital role in the all-inclusive care model of Neighborhood Healthcare PACE and collaborates with the interdisciplinary care team to ensure accurate abstracting and coding of Hierarchical Condition Categories (HCC) to the highest level of specificity. Primary responsibilities include auditing medical record data for adherence to compliance and identifying training opportunities for providers.

RESPONSIBILITIES

• Provides detailed auditing of medical records for completeness, clarity and accuracy in accordance with coding guidelines and policies
• Abstracts diagnoses from clinical documentation to assign codes to presenting chronic conditions
• Analyzes participant clinical charts, diagnosis data, CPT Codes, and any other diagnostic data for PACE organization to assess chart coding accuracy for RAPS submissions
• Works collaboratively with PACE providers to develop positive rapport while maintaining the ability to effectively communicate and resolve coding and documentation discrepancies
• Identifies educational needs and disseminates clinical coding and documentation references to providers and trainings when needed to provide solutions for improvement of quality and accuracy
• Organizes and prioritizes all work to ensure that records are coded in time frames that will be in line with department policies
• Utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff
• Develops, implements, and consistently seeks improvement in policies and procedures for all billing and reimbursement functions to ensure department activities are carried out in accordance with industry standards and optimizes revenue
• Researches and maintains knowledge and understanding of HCC/risk adjustment, CPT and ICD-10 coding and documentation requirements per Medicare guidelines
• Stays current on Continued Education Units to maintain coding certification

EDUCATION/EXPERIENCE

• High School Diploma/GED required, Bachelor’s Degree preferred
• Current Certification(s) from AAPC or AHIMA (CPC, CRC, CCS, or CCS-P) required
• Three years of CPT, ICD-10 coding systems, and chart review experience required
• Experience educating healthcare providers regarding coding and documentation preferred

ADDITIONAL QUALIFICATIONS (Knowledge, Skills and Abilities)

• Strong knowledge of risk adjustment, Hierarchical Condition Category (HCC), medical terminology and medical chart review
• Knowledge and understanding of ICD-10-CM, CPT, HCC, and HCPCS coding guidelines and practices for outpatient coding in a PACE program setting
• Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledgeable about and understanding of electronic management systems
• Ability to interpret and apply federal and state coding and billing regulations for chart reviews
• Excellent planning and organizational ability
• Ability to work with highly confidential information in a professional and ethical manner
• Strong analytical, problem-solving, and written communication skills
• Ability to successfully manage multiple tasks simultaneously and maintain organization
• Ability to work as part of a team as well as independently

Physical Requirements

• Ability to lift or push 15 lbs.
• Ability to stand or sit for long periods of time

COMPLIANCE (Safety & HIPPA)

• Follow all safety procedures as outlined in Neighborhood Healthcare’s Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately
• Maintain current knowledge of policies and procedures as they relate to safe work practices
• Use appropriate body mechanics to ensure an injury free environment
• Be familiar with location of nearest fire extinguisher and emergency exits
• Follow all infection control procedures including blood-borne pathogen protocols
• Maintain privacy of all patients, employee and volunteer information and access such information only on a need-to-know basis for business purposes
• Comply with all regulations regarding corporate integrity and security obligations
• Report all behavior and/or activity that are unethical, fraudulent, or unlawful

Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more!

Pay range: $30.09 – $38.84 hourly rate, depending on experience, education and additional qualifications.