Inpatient/Outpatient Coder

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Inpatient/Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for: physician documentation, clinical evidence that supports the diagnoses, medical necessity of procedures, appropriate setting of care and accurate use of CMS coding guidelines.

• Identifies trends and inconsistencies in provider documentation and coding practices.
• Audits and reviews medical records to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy.
• Develops curriculum to improve provider coding practices.
• Educates providers and their practice staff in coding guidelines.
• Works in collaboration with other departments, develop plans and materials that support education and system changes to ensure proper coding is a standard practice for all providers.
• Participates in the review and analysis of summary data. Assist with data collection and report generation.
• Maintains the confidentiality and security of sensitive information and files.

• Associate degree required.
• 3-5 years health care experience in a physician group practice or other ambulatory care setting preferred.
• 1+ years of medical coding experience with demonstrated sustained coding quality.
• In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, APR-DRG/MSDRG and APC/APG prospective payment systems
• Demonstrates advanced knowledge of CPT/HCPS/Revenue Code procedure coding, ICD-9/ICD-10 coding principles and practices.
• Ability to research authoritative citations related to coding, compliance, and additional reporting requirements.
• Demonstrates overall knowledge of claims processing for various insurances both private and government

Licensure and/or Certification Required

• Certification as a professional coder (CPC)

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication
• Excellent verbal and written communication skills
• Excellent computer skills. Able to learn, use and toggle between multiple systems.
• Analytical skills and ability to create reports, charts, and graphs (e.g. Microsoft Excel)
• Ability to work independently or in a team setting, while handling multiple projects and adjusting to changes quickly while meeting all deadlines

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