Work Location(s): Las Vegas, NV, US
The Care Delivery Organization (CDO) Medical Coder conducts review of medical records to apply medical codes (ICD10, CPT, CPTII) for professional services that will be submitted to payers. The CDO Medical Coder work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coder assumes ownership and leads advanced and highly specialized administrative & operational support duties that require independent initiative and judgment.
This role requires a thorough understanding of the relationship between codes and revenue in the reimbursement process, specifically how revenue is generated from ICD-10CM, CPT and HCPCS codes. The Care Delivery Organization Medical Coder must maintain current knowledge of regulatory changes that impact documentation, coding and billing practices as well as understanding of clinical operations, coding and billing office workflows.
The CDO Medical Coder conducts medical record reviews to apply quality data and medical codes that are submitted to the Centers for Medicare and Medicaid Services (CMS), payers, and other government agencies. The CDO Medical Coder ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. May participate in provider education programs on coding compliance.
The Coder will communicate information regarding medical documentation and coding best practices to assigned providers and will need to build relationships with providers and stakeholders. Responds to or clarifies internal requests for medical information. Analyzes, enters and manipulates database. Understands department and organizational strategy and operating objectives. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
- HS diploma/GED
- CPC (Certified Professional Coder) Certification required or AHIMA CCS-P
- Strong knowledge of Microsoft Office products (Outlook, Word, Excel, Teams)
- Strong written and verbal communication skills; strong analytical, organizational and time management skills
- 2 years’ experience coding in a value based care medical office environment
- In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.
- Understanding of the application of authoritative guidance to the interpretation and analysis of documentation, coding, and queries.
- Ability to build and maintain effective relationships with internal stakeholders
- Demonstrated strong interpersonal communication including a willingness to consistently provide superior customer service and the ability to react with a professional demeanor
- This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Associate’s degree in related healthcare field
- eCW experience
- Bachelor’s degree
- Experience in a fast paced, metric driven operational setting
This position may qualify to work at home but will require 1-2 days in office work, and occasionally more. Employee must live within driving distance to office and be available to come to the office as needed. Work at home privileges are earned over time. Associate will need to demonstrate results as well as competency in care model, professionalism, and engagement to qualify for work at home privileges.
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Scheduled Weekly Hours
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