Medicaid Coding Specialist | IEHP


Job Requisition ID: 6612

Position Summary/Position

Under the direction of the Risk Adjustment Leadership Team, the Medicaid Coding Specialist performs ongoing reviews of electronic and paper based medical charts to ensure accuracy, completeness and specificity of codes captured in the encounter submission is substantiated in the medical record as assigned in an effort to improve IEHP data reporting to Centers for Medicare & Medicaid Services (CMS). The Medicaid Coding Specialist will provide subject matter expertise to assist physicians and healthcare providers in understanding the importance of quality data programs as it relates to payment methodology, and the importance of proper chart documentation of diagnoses coding. This position will assist in IEHP efforts to maximize medical record documentation standards, and member care.

Major Functions (Duties And Responsibilities)

  • Conduct ongoing clinical chart reviews onsite or remotely.
  • Target providers who would benefit from clinical documentation training.
  • Educate providers on how to improve their quality scores which measures their patient’s health.
  • Performs ongoing related process improvement projects assigned by the Manager in an effort to compile accurate and complete data to maximize IEHP’s compliance efforts.
  • Develop comprehensive, provider-specific plan to increase their quality.
  • Works independently using professional discretion and judgment.
  • Implement education to provide formal training to providers and staff as required.
  • Meet and maintain productivity and accuracy metric of 95%.
  • Identify trends and opportunities to improve efficiency and quality.
  • Utilizing data analytics identify and target providers to discuss improving the quality of care and suspected conditions.
  • Assist with all regulatory, internal, external or vendor audits as required.
  • Enhance professional growth and development through educational programs.
  • Performs standard work and assists with additional projects as required to ensure that Health Plan operations are successful.

Supervisory Responsibilities

Leading: Self

Experience Qualifications

Two (2) years experience in Coding. Must have strong chart audit experience in coding. AHIMA or AAPC Certified Coder experienced in managed care, program/project management, data analysis and interpretation.

Preferred Experience

Experience in Coding in an HMO Setting is preferred. Knowledge of HCC coding is a plus.

Education Qualifications

High School Diploma or GED required.

Professional Certification

AHIMA or AAPC Certified Medicaid Coding Specialist required.

Drivers License Required

Yes, must have a valid California Driver’s license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement

Knowledge of coding for all lines of business. Knowledge of coding processes, guidelines and working knowledge of Centers for Medicare & Medicaid Services (CMS). A working knowledge of the official ICD-10-CM coding guidelines, CPT, HCPCS and E&M guidelines are required. Knowledge in clinical processes and methodology concepts as they relate to all lines of business and Part D plans is required.

Skills Requirement

Excellent written, oral, and presentation skills, proficiency in Microsoft Word, Excel, and other computer applications.

Abilities Requirement

Ability to take general direction and manage complex projects within deadlines. Must have attention to detail, the ability to organize and prioritize standard work.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

Must have reliable transportation, with a current automobile insurance, and a current state-issued driver’s license. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Starting Salary: $66,040.00 – $84,219.20

Pay rate will commensurate with experience

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

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