Outpatient Coder
Job Description
Position Purpose: This position reports to the Manager of Risk Adjustment Coding for Steward Health Care Network in Needham, MA. As a member of the Risk Adjustment team, the Outpatient Risk Coder works remotely in collaboration with Providers and Practice Staff with opportunities for improved quality, risk adjustment coding performance. The Outpatient Risk Coder is a valuable resource in process improvement and identifying clinically appropriate risk adjusting conditions to capture. Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, at multiple practice locations, with significant attention to detail for completion of both verbal and written external communications.
- Review outpatient medical record information on both a retroactive and prospective basis to identify, assess, monitor and document claims and encounter coding information as it pertains to risk adjustment and quality metrics
- Ensure that the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe
- Assess adequacy of documentation of claims and query outpatient provider claims to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
- Audit provider documentation ICD-10 codes to ensure adherence with CMS Risk Adjustment guidelines
- Ensure that quality gaps are being closed while reviewing the medical records, adding CPT Category II codes to claims when appropriate and making sure quality measure documentation is available to be uploaded back to the payers.
- Participate in departmental and physician network performance improvement initiatives.
- Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security.
- Performs other duties as requested.
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About Steward Health Care
Over a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.
As the country's largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.
Based in Dallas, Steward currently operates more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas.
For more information, visit steward.org
Application Instructions
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