Position: HCC Certified Coder

The Monogram HCC Certified Coder will abstract clinical information and assign appropriate diagnosis and procedure codes in accordance with nationally recognized coding guidelines. The HCC Certified Coder will analyze and translate medical and clinical diagnoses, in adherence with the CMS Risk Adjustment Models. The successful candidate will work as a team with our coding team and providers. Primary duties include auditing patient health assessment, peer coding quality reviews, provider and coding team training and education. Performs medical chart audits on prospective basis to identify, monitor and document claims and encounter coding information as it relates to Hierarchical Condition Categories (HCC). Performs coding abstraction and medical chart quality audits to ensure clinicians have accurate clinical documentation to support ICD-10 codes and are adhering to CMS Risk Adjustment guidelines. Educates clinicians on specific coding issues found in their charts and keeps them abreast of coding and documentation guidelines.

Roles and Responsibilities

• Maintains 95% coding accuracy rate
• Maintains production goals
• Experience working remotely with proven ability to prioritize tasks, meet goals and deadlines
• Performs accurate and timely coding (CPT, ICD-9, ICD-10, HCPCS, modifiers).
• Demonstrate advanced knowledge of medical terminology, anatomy, and physiology
• Provides timely correspondence with providers regarding clinical documentation opportunities and queries.
• Identifies trends through data analysis or chart review, reviewing existing policy for accuracy and developing new policies and recommends solutions to meet objectives.
• Keeps abreast of mandated regulatory, documentation and coding guidelines to documentation, including demonstrated proficiency with all areas of CPT, ICD-10 and HCPCS coding. E/M code assignment, auditing, and education.
• Performs quality audits, education, and training for coding team.
• Works closely with leadership to create coding tools for coding team and providers.
• Performs other duties as required or assigned

Position Requirements

• CPC, CCS, or CCS-P credentials, required
• CRC credentials, required
• 3+ years’ experience in Certified Coder role
• 3+ years’ experience in HCC coding
• Experience with Athena is a plus.
• Experience with medical billing is a plus.
• Experience coding Nephrology is a plus.
• Must have proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Record
• Experience communicating & working closely with Physicians
• Experience in Medicare programs and regulations including fraud and abuse and Risk Adjustment
• Familiar with STARs performance measures and metrics.

Benefits

• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
• Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources
• Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave
• Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts

About Monogram Health

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.

Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.