“Sanitas is a global healthcare organization expanding across United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.”
Job Summary
The Medicare Coder Specialist facilitates modifications to clinical documentation through pre visit and post visit interaction with providers and other members of the healthcare team. He or she promotes capture of clinical severity (later translated into coded data) to support the level of service rendered to relevant patient populations, enhance evidence-based medicine, promote continuity of care, improve capturing chronic conditions. Responsible for coding all medical services procedures CPT and HCPCS codes, pharmaceuticals supplies, patients’ ICD-10 diagnoses, signs, and symptoms when applicable, ensuring that all assigned ICD-10-CM codes are supported by proper clinical documentation
Essential Job Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Clinically evaluate how the health record translates into coded data, including review of provider and other clinician documentation, lab results, diagnostic information, and treatment plans Daily review of outpatient medical records during pre-visit and post-visit review. Communicate with providers either through discussion or in writing (e.g., formal queries) regarding missing, unclear, or conflicting health record documentation, and clarify the information as warranted. Communicate with appropriate clinical team members to promote accurate and complete documentation of diagnoses and/or procedures in the health record that have direct bearing on plan of care. Gather and analyze information pertinent to documentation findings and outcomes and use this information to develop action plans for process improvement. responses have been appropriately documented. Collaborate with HIM/coding professionals to review individual problematic cases and ensure accuracy of final coded data in conjunction with CDI managers, coding managers, and/or physician advisors. Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization. Develop provider education strategies to promote complete and accurate clinical documentation and correct negative trends. Identify patterns, trends, variances, and opportunities to improve documentation review processes. Enhance expertise in query development, presentation, and standards (including an understanding of published query guidelines and practice expectations for compliance). Conduct independent research to promote knowledge of clinical topics, coding guidelines, regulatory policies and trends, and healthcare economics. Support any ongoing program that minimizes any organizational risk in the event of a Risk Adjustment Data Validation (RADV) Audit. Educates providers on HCC Coding and clinical documentation requirements related to Risk Adjustment. Works with Suspect and dropped reports. Comply with HIPAA and code of conduct policies. Interact with appropriate resources that support growth and education of the CDI team. Utilize the clinic’s designated clinical documentation system to conduct reviews of the health record and identify opportunities for clarification.