Coding Specialist 1

DaVita Medical Group - El Segundo, CA

Full-time
OVERVIEW:
Responsible for participating in the implementation of the organization’s Coding Proficiency program. Performs medical chart audits for Evaluation and Management and ICD-9 coding and documentation. Interfaces and disseminates audit results to clinicians and management.

ESSENTIAL FUNCTIONS:
Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Performs medical chart audits meeting minimum productivity standards.
Educates clinicians on specific coding issues found in senior HMO pre-audits.
Submits and follows up on query forms to clinicians based on “inferred” chart audit data.
Submits weekly audit totals to Coding management.
Performs claims analysis for appropriate CPT and ICD-9 coding.
Identifies CPT unbundling in claim submissions.
Uses coding knowledge to work the claim system edits.
Performs Coding analysis of claims denials.
Reviews TES edits for coding analysis.
Works with Claims management and IPA / contracted clinicians on claim edit resolution.
Stays abreast of industry coding and compliance issues.
Participates in coding / auditing discussions to ensure best practice efforts and processes are implemented ensuring maximum reimbursement through appropriate coding.
Attends Coding program monthly meetings.
Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.

EDUCATION:
One or two years of post-high school education or a degree from a two-year college.
Coding certification through AAPC or AHIMA required.

EXPERIENCE:
Minimum:
Over 1 year and up to 3 years of experience of ICD9, CPT and HCPCS coding experience or successful completion of Coding Program internship.

Preferred:
3 years medical billing or health care experience.
IDX BAR experience.
Allscripts / Enterprise experience.
Clinical experience.

KNOWLEDGE, SKILLS, ABILITIES:
Computer literate with medical billing software.
Proficient in Word, Excel, PowerPoint, Multi-media projector.
Knowledge of CMS coding guidelines.
Excellent verbal and written communication skills in the English language.
Must be able to work independently to carry out work efforts.
Bilingual / Spanish preferred.
What's the first thing that happens when one of the leading independent medical groups in the country comes together with a global leader in health care? Opportunity. With DaVita Medical Group, HealthCare Partners, The Everett Clinic, Northwest Physicians Network, MountainView Medical Group and Magan Medical Clinic joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. We're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(SM)

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Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.