Facility: Corporate Offices

City San Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

Certified Professional Coder (CPC) - AAPC; H.S. Diploma or Equivalent

Hours :

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$32.283 - $41.655 - $51.028

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

Provides administrative and coding support to management, site support, staff and physician offices. Identifies and reports documentation and coding opportunities and makes recommendations for improved code capture and reporting. Monitors and reports coding trends. Immediately communicates coding discrepancies to management. Works to improve overall provider accuracy.

Required Qualifications

• H.S. Diploma or Equivalent

• 3 Years experience working as a certified coder.

• 2 Years experience working as a HCC risk adjustment coding auditor.

• Experience with medical billing and with medical terminology.

• Certified Professional Coder (CPC) - AAPC -REQUIRED

Essential Functions

• Act as a resourceRequests, reviews and codes medical services from reports and notes in order to convert procedural and diagnostic notes into appropriate levels of care following coding rules and regulations.Applies understanding of Medicare, Medi-Cal and other payor guidelines.Identifies documentation deficiencies and recommends methods for resolution that satisfy regulatory and SCMG compliance requirements.Performs medical chart audits meeting minimum department productivity standards. Exercises mature judgment and maintains confidentiality in all activities.Educates clinicians on specific coding issues based on medical records review and coding principles.Educates clinicians and their staff on the HCC/Risk Adjustment coding guidelines and makes recommendations for documentation improvement.Educates clinicians on coding updates and processes.Serves as a key resource for documentation requirements and training on the documentation requirements needed for each HCC/RAF recorded.Develop and build relationships with clinicians and their staff to achieve improvements in risk adjustment documentation, data validations, as well as program participation.

• Coding and complianceIdentifies areas of potential coding, billing and documentation deficiencies. Provide suggestions to resolve areas of deficiencies to management.Conducts audits and gap analysis then develops and implements action plans to address issues identified through the audit/analysis.Identifies areas of potential compliance risk and notify management immediately.Identifies anomalies in coding.Identifies ways to avoid errors and issues and creates safeguards to prevent them from happening again.Identifies coding trends and risk.Ensures the accuracy of all work.

• Data collection and reportingHas knowledge of coding software, databases, EHRs such as GE (IDX), MCA, Touchworks, Cerner, as well as all other applications used by SCMG/Sharp.Increase knowledge of electronic data systems and reporting tools to enhance value.Design and develop special reports within a specified timeframe.Participate in job related conferences, seminars and workshops.Review various coding publications for changes and relay information to pertinent parties.Identifies P4P metrics documentation.

• Other dutiesParticipates in special projects that improve department production and/or efficiency.Identifies and trends errors.Perform other duties as assigned.

• Process improvementIndependently researches coding questions, documents findings, makes recommendations and provides documentation that supports the recommended solutions.Provides professional and courteous support to clinical providers through email, phone and in-person contact, answering questions and providing supporting documentation.Provides timely and accurate answers to inquiries presented by customers on clinical coding issues.Maintain a positive attitude and productive relationship with peers, physicians, coworkers and management.Provides updates and status reports to management.Participates in coding/auditing discussions to ensure that the best practice efforts and processes are followed to allow for maximum reimbursement through appropriate coding.Performs chart audits, to provide education to providers and staff to improve overall documentation and coding accuracy.

• Professional developmentMaintains knowledge of Touchworks, Interfaces, Cerner, etc.Teaches others updated methods as well as documents them for the betterment of SCMG overall success.

Knowledge, Skills, and Abilities

• Familiarity with radiology and laboratory coding. Knowledge of Coding Procedures and Medical Terminology.

• Proficient on CPT, HCPCS and diagnosis coding in an ambulatory setting.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class