United States onlyEmployment Type:
Full timeShift:
Day ShiftDescription:
Why MediGold?
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
About the job:
The Risk Adjustment Coding Specialist works in a team environment and is responsible for retrieving, reviewing, and assigning the appropriate ICD-10 medical diagnosis for outpatient/inpatient record types .
What you'll do:
Reviews patient record prior to appointment to determine Gaps in Care, then communicates Gaps to provider.
• Educates and assists Coding Specialists to accurately code ICD-9/10 to highest level of specificity.
• Follows current industry standards of ethical coding.
• Recognizes opportunities for documentation improvement and educates providers and staff of suggested improvements.
• Works collaboratively with providers to completely reflect patient's clinical status and care; works with providers to develop documentation improvement plans.
• Collaborates with providers to formulate appropriate modifications to clinical documentation to reflect the appropriate use of clinical codes and documentation.
• Responsible for retrieving, reviewing, and assigning proper ICD-10 codes to inpatient/outpatient records.
• Submits appropriate coding output file for appropriate ICD-10 reporting to CMS.
• Reviews Payor data for Gaps in Care and RAF Scores
Other Job Responsibilities
• Completes and submits Medicare Patient Assessment Forms and maintains accurate database of submission and payment.
• Ensures medical documentation and coding compliance with Federal, State and Private payer regulations.
• Travel to provider offices or CSC to retrieve medical records.
• Assist in CMS IPM’s and other Federal Audits.
• Participates in seminars and continuing education activities pertinent to areas of job responsibility
• Responsible for compliance with Organizational Integrity through raising questions and promptly reporting actual or potential wrongdoing.
• All other duties as assigned.
What we're looking for:
Education: High School Diploma or equivalent required. Associate or bachelor’s degree in health information management technology or related field is preferred.
• Licensure / Certification: Certification eligible as CCA, CCS, CCS-P, RHIT, RHIA Certification eligible as CCA, CCS, CCS-P, RHIT, RHIA (recognized by American Health Information Management Association) or CPC (recognized by Association Academy of Professional Coders preferred). CRC (Certified Risk Adjustment Coder certification within one year of hire required).
• Experience: Minimum of two years of experience in medical coding and billing required
• Effective Communication Skills
• Understanding of various medical claims formats.
• Working knowledge in medical terminology, CPT and ICD-9/10 coding, and subsequent ICD versions.
• Expanded knowledge of Risk Adjustment and HCC coding.
• Knowledge of payer contracts and reimbursement.
• Thorough working knowledge of Federal, State and Private payor regulations.
Position Highlights and Benefits:
- Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
- Retirement savings account with employer match starting on day one.
- Generous paid time off programs.
- Employee recognition programs.
- Tuition/professional development reimbursement.
- Relocation assistance (geographic and position restrictions apply).
- Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
- Employee Referral Rewards program.
- Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!
- Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.
Ministry/Facility Information:
Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our four hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
