Bilingual Certified Medical Coder
Associate III - BPM
Who we are:
UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers — and better outcomes for our communities.
We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.
You Are:
The Bilingual Certified MRA Coder II will perform retrospective coding and prospective CDI Opportunity Review to assist healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation. The Coder II will conduct audits to abstract data not submitted by providers and initiate opportunities to improve clinical documentation, accuracy, completeness, and compliance to enable providers to deliver the highest level of quality of care.
The Opportunity:
- Ensures compliance with all applicable Federal, laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System.
- Performs on-site medical record review to capture of all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system.
- Ensure diagnosis codes are supported by the documentation and ensure adherence with ICD-10CM Guidelines for Coding and Reporting.
- Focus on retrospective coding to close HCC gaps and add HCC codes not reported, including the prospective review and creation of CDI opportunities.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
What you need:
- High School diploma or equivalent required.
- Bachelor’s degree in a related field preferred. Successful completion of a coding license or certificates; CPC, COC, CRC, CPMA, or CCS-P. Continuous learning, as defined by the Company’s learning philosophy, is required.
- Minimum two (2) years HCC specific Coding.
- Clinical background preferred.
- Experience and understanding of CMS HCC Risk Adjustment coding and data validation requirements.
- Initial demonstration and maintenance of continuing education/membership is required.
- Excellent organization and problem-solving skills.
- Strong oral and written communication skills.
- Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology, and concepts of disease processes.
- Extensive knowledge of ICD-10-CM coding guidelines.
- Advanced technical skills for use of MS Office (Excel, Word, Outlook, and PowerPoint)
- Demonstrated ability to utilize a variety of electronic medical records systems.
- Ability to manage a significant workload, and to work efficiently under pressure, while meeting established deadlines with minimal supervision.
- Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization.
- Strong time management skills.
- Must possess a high degree of accuracy, efficiency, and dependability.
- Excellent written and oral communication for representation of clear and concise results.
- Ability to read documents written in Spanish.
Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.
Role Location: Remote
Compensation Range: $52,000-$72,000
Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits.
What we believe:
We’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do.
Humility:
We will listen, learn, be empathetic and help selflessly in our interactions with everyone.
Humanity:
Through business, we will better the lives of those less fortunate than ourselves.
Integrity:
We honor our commitments and act with responsibility in all our relationships.
Equal Employment Opportunity Statement
UST HealthProof 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, or status as a protected veteran.
UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.
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