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Hipaa Certified Medical Coder - 12-Month Contract

Eingestellt von Enclipse Corp.

Gesuchte Skills: Cms, Support

Projektbeschreibung

HIPAA CERTIFIED MEDICAL CODER

PERIODwhich may include but is not limited to:

- Assist with program assessments.
- Utilization of General Equivalency Mappings (GEMs).
- Update Crosswalks.
- Review code set impacts on systems and program areas.
- Update of Native Processing maps.
- Adjust OHC ICD-10 products to reflect coding updates.
- As directed, work with other agencies and staff to refine methodology and implementation strategies, policies, procedures, and systems requirements for the use of ICD-10 codes.
- Attend and chair meetings in conjunction with or as directed by staff.
- Participate in workgroup activities with staff, Medi-Cal providers, and managed care plans.
- Assist in the development of codding requirements to be translated to paper, electronic professional and/or institutional billing forms (ie, Centers for Medicare and Medicaid Services (CMS) - 1500/UB-04).
- Research business rules and requirements.
- Research coding solutions and requirements of similar services from other health insurance payers such as Medicare, commercial health plans, and other state Medicaid programs.
- Develop Microsoft PowerPoint presentations and present in a workgroup/or meeting environment.
- Develop and maintain electronic processes and procedures for collecting and organizing information regarding medical coding requirement.
- Educate and train company medical, policy, systems staff, and other internal/external stakeholders on HIPAA mandated code sets; support industry-recognized coding standards that promote standardization of Medi-Cal codes.
- As directed, provide coding analysis and solutions on all company coding activities including but not limited to:
- ICD-10 CM/PCS Diagnosis code conversion
- National Correct Coding Initiative (NCCI)
- Administrative codes
- Annual Healthcare Common Procedure Coding System (HCPCS) updates
- Dental Procedure Codes (DPC) updates
- All other code sets
- Monitor and report federal, state legislation that could affect ICD-10 code conversion and achieve working familiarity on all rules and regulations.
- As directed by staff, assist in the development or revision of reports or other documents (eg requests) needed for reporting and communicating to CMS or other agencies.

UPDATE AND MAINTAIN THE CODE MANAGEMENT TOOL DATABASE:

- Provide coding expertise and maintenance for code set maintenance software, collaborating with clinical policy leads as directed.
- Serve as the coding liaison to program policy areas.
- Provide updates to ICD-10 CM/PCS Diagnosis.
- Provide updates to HCPCS codes.
- Provide updates to CPT codes.
- Incorporate NCCI edits.
- Provide updates to administrative codes.
- Provide updates to diagnosis codes.
- Provide updates to dental codes, if directed.
- Provide updates to all code sets.
- Track historical use of codes (initiation and end-date of codes).
- Assist with maintenance of TAR/SAR requirements.
- Incorporation legislation and rational that affect codes.
- Assist with identifying linkage of codes sets with clinical quality measures, such as Meaningful use, HEDIS, Healthcare Associated Infections.
- Assist with linkage of codes to a web-based provider manual.
- Assist in educating policy doctors, nurses and programs with proper use of coding tool database, and upkeep of operating manuals for the Code Management Tool.
- Provide coding expertise as needed to interface with IT systems, including CA-MMIS, PCES, Short Doyle, Denti-Cal, and other IT systems.

PERFORM DUTIES IN A PROJECT MANAGEMENT ENVIRONMENT:

- Report to OHC management on a daily, weekly and monthly basis on coding issues and report status including but not limited to:
- Submission of monthly status reports documenting the accomplishments for the month, planned accomplishments for the coming month, a list of all activities currently assigned.
- Weekly submission of hours to OHC contract managers.
- Weekly/monthly submission of updates to risks and issues.

MANDATORY QUALIFICATIONS:

- Knowledge of ICD-9 and ICD-10, Current Procedure Terminology (CPT), and Health Care Procedure Coding Standardization/Systems (HCPCS) Level II coding standards
- Knowledge of Centers for Medicare and Medicaid Services (CMS) 1500 and Universal Billing (UB) UB-04 claim forms and billing requirements.
- Knowledge of all medical coding standards and code sets.
- Knowledge of Standard Setting organizations:  American Medical Association (AMA), National Uniform Claims Committee (NUCC), National Uniform Billing Committee (NUBC), Centers for Medicare and Medicaid Services (CMS).
- Knowledge of Medicaid, Medicare, and third-party payer requirements.
- Excellent written and oral communication skills.
- Strong computer skills, including knowledge of MS Word, MS Excel, and MS PowerPoint.
- Minimum 3 years' medical coding experience in hospital, clinic outpatient setting, or health insurance carrier environment.
- THE PROPOSED CERTIFIED MEDICAL CODER MUST BE CERTIFIED BY THE AMERICAN HEALTH INFORMATION MANAGEMENT ASSOCIATION (AHIMA) OR AMERICAN ACADEMY OF PROFESSIONAL CODERS (AAPC) AS AN ICD-10 CERTIFIED CODER OR INSTRUCTOR/TRAINER; AND HAVE CURRENT CERTIFICATION IN AT LEAST ONE OF THE FOLLOWING CATEGORIES:
- Certified Coding Specialist (CCS)
- Certified Coding Specialist - Physician (CCS-P)
- Certified Procedural Coder (CPC)

DESIRABLE QUALIFICATIONS:

- Knowledge of Medi-Cal billing policies and requirements.
- Experience preparing training materials and executing training forums (classroom, etc).
- Knowledge of MS Access, MS Project.
- Experience in state policy and regulation formation.
- Preferred BA/BS in a health related field.
- Prior experience in performing ICD-10 analysis.
- Working knowledge of General Equivalency Mappings (GEMs).
- Knowledge of Health Insurance Portability and Accountability Act (HIPAA).
- Prior experience in training.

Projektdetails

  • Vertragsart:

    Contract

  • Berufserfahrung:

    Keine Angabe

Geforderte Qualifikationen

  • Kategorie:

    Webentwicklung, Sonstiges

  • Skills:

    cms, support

Enclipse Corp.