FFS & MRA Coding Specialist en P3 Health Partners

Description 

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. 

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.   

We are looking for a FFS and MRA Coding Specialist.  If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team. 

Coding Specialist  

Overall Purpose: 

The FFS and MRA Coding Specialist conducts concurrent review of all Medicare and Medicare Advantage encounters and supports the providers by ensuring documentation supports the submission of relevant ICD-10-CM, MRA/HCC, E&M, CPT, HCPCS  CAT II and Quality HEDIS/Stars code information in accordance with national coding guidelines and appropriate reimbursement requirements.  This person will ensure member encounter data (services and disease conditions) is being accurately documented and relevant procedural codes and diagnosis codes are captured. The outcome will be accurate and complete capture of all relevant code sets that are supported by the clinician documentation for each encounter reviewed. 

Education and Experience:  

• High school diploma or equivalent required. 
• Certified through AAPC or AHIMA (CPC, CCS, RHIT), along with CRC preferred or willingness to obtain 
• Experience and Knowledge of CMS FFS coding guidelines and methodologies including:  AWV, LCD/NCD, Modifiers, Quality HEDIS/Stars and billing rules 
• Experience and Knowledge of MRA HCC coding guidelines and methodologies including: ICD-10-CM, CMS, AHA Coding Clinic and HHS 
• 3+ years of coding and audit experience and understanding of E&M, CPT, ICD-10-CM, MRA/HCC, HCPCS, CAT II and Quality HEDIS/Stars 
• Advanced proficiency with Microsoft Office 
• Extensive knowledge of medical terminology and ability to research coding related questions 
• Ability to effectively and compliantly query and communicate with clinicians and clinic support staff 
• If working remotely, must be able to work independently, in a quiet and distraction-free environment 
• As part of the screening process, all coders must take and pass a coding test (with 90% accuracy) 

Knowledge, Skills and Abilities: 

• Ability to work independently and collaboratively in a fast-paced team environment 
• Excellent verbal, written and interpersonal communication skills 
• Dependable, highly motivated team player with a great attitude 
• Possess strong organizational skills and attention to detail technically savvy, self-motivated, with the ability to troubleshoot and problem solve 

Essential Functions: 

• Apply knowledge of CMS, MRA, Payor and P3 coding guidelines. 
• Medical records (notes/charts) will be assigned to review and code electronically 
• Abstract and code ICD-10-CM, MRA/HCC, CPT, HCPC’s, CAT II and HEDIS/Stars codes from documentation, sending queries when necessary 
• Perform ongoing analysis of medical records for appropriate coding compliance 
• Ability to research CMS and Payor rules as appropriate to determine appropriate coding and billing guidelines. 
• Research and resolution of coding projects as assigned 
• Responsible for daily production goal and quality goal of 95% accuracy 
• Attend conference calls as necessary to provide information and/or feedback 
• Other duties as assigned by supervisor/manager 

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities 

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)