Medical Coder

POSITION:                           Medical Coder

STATUS:                               Non-exempt; Full time

REPORTS TO:                      Billing Manager

SUPERVISES:                       None

DEPARTMENT:                     Fiscal

UNIT:                                      Billing

OFFICIAL DUTY STATION: Administrative Office (4216 Fountain Avenue, Los Angeles, CA 90029)

SUMMARY:   

This position performs coding and audit functions.

APHCV expects all employees to respond and participate to emergency situation per emergency policies and procedures.

APHCV requires all staff to comply with Standards of Conduct and Compliance Program related policies and procedures. Such compliance is part of this position’s performance evaluation. 

APHCV is a tobacco free organization.

DUTIES AND RESPONSIBILITIES:

1. Conduct various activities to improve coding, particularly but not limited to HCC coding for Medicare and other line of products)
2. Audit Medicare (and other line of products such as Medi-Cal) Managed Care (HCLA IPA) charts daily (pre-visits and post visits) following the audit tools, guidelines, policies and procedures to review the appropriate CPT, ICD, HCPCS, and HCC coding.
3. Recommend the appropriate code for HCC and non-HCC to providers through EHR template.
4. Flag incorrect coding, inadequate documentation, and send recommendation to individual provider through EHR tasking. Ensure the new correct codes and sufficient documentation are being re-submitted and documented when appropriate. Re-submit the corrected encounters to HCLA IPA.
5. Run and review various HCC reports according to policies and procedures.
6. Select and review charts for coding audit based on APHCV annual goals and directions. Provide recommendations to Billing Manager, Medical Director and Providers for improvement.
7. Prepare coding audit findings annually for Billing Manager to present to TQM annually to ensure billing and coding compliance.
8. Work closely with the providers and the coder from Health Care LA IPA to improve correct coding and HCC score to meet APHCV goal.
9. Provide on-going one-on-one consultation and training to providers as needed. Traveling between APHCV site locations may be required.
10. Attend coding education, trainings, and meetings and maintain up-to-date level of knowledge on primary care and HCC coding. 
11. Provide coding updates, group education, and group training to providers and billing staff as needed.
12. Provide coding support to all providers, clinic staff, and billing staff. This includes, but not limited to, reviewing consultation reports and provide correct codes requested by Medical Records, IT, and Referral Staff.
13. Review consultation reports and code DM Retinal Eye Exam result CPT II on a weekly basis.
14. Select an encounter daily to audit the applicable depression diagnosis code according to PHQ-9 score.
15. Assist with other coding related tasks to help improve clinical quality and incentives such as completion of health plan AWV forms in coding section.
16. Review unbilled encounters of the leaving providers to ensure all encounters are completely documented, coded, and billed before providers leave APHCV practice.
17. Maintain up-to-date coding activities.
18. Perform other duties that may be assigned from time to time.

• Certified Medical Coder (CPC, CCS-P, or RMC) and 2years minimum experience as a medical coder in a non-profit health care organization
• Proficiency in Microsoft Office Applications
• Experience in NextGen preferred

HR Procedural requirements:

• Legal authorization to work in the United States 
• Completion of APHCV Health Assessment Form
• Completion of background check

Salary : $30 - $33