Coding Support Specialist - Summit Medical Group

About Our Career Opportunity

Summit Medical Group is seeking Risk Adjustment Coding Support Specialist to perform a comprehensive documentation review of the outpatient Progress Notes for assigning the appropriate ICD-10 diagnosis codes for accuracy of disease burden.  This is a Full time opportunity. 

This is a Value Based Care organization that is rapidly expanding with room for growth and opportunities within. In compliance with CMS and the Official Coding Guidelines in ICD-10-CM, this position identifies conditions through clinical documentation reviews specific for HCC Risk Adjustment Data Validation. The goal is to accurately represent the patients fully documented disease burden in accurate diagnosis codes for communication to CMS for Risk Score Assignment. This is NOT a medical billing position, there is NO CPT code assignment, and NO revenue cycle management.. This is a position is in Risk Adjustment for CMS with HCC diagnosis coding. 

Clinical knowledge and/or disease burden awareness and high level analytical skills are utilized in the clinical documentation reviews and diagnosis code assignment. Record review consists of reading and reviewing clinical documentation within the electronic health record for ICD-10 code assignment. You must like to read.

EXAMPLES OF DUTIES: (List does not include all duties assigned)

• Review of clinical documentation in the progress note for accuracy of diagnosis coding to the highest level of specificity in a timely and efficient manner.
• Through progress note and electronic health record reviews, accurately correct/assign diagnosis codes to ensure ICD diagnosis coding and clinical documentation criteria, rules and guidelines have been met in accordance with policy.
• Through progress note reviews, identify, and report trends observed for educational opportunities in clinical documentation specificity, diagnosis coding to the highest specificity in addition to reporting any documentation trending, provider feedback and/or communications for improvements, training, and educational opportunities for staff and/or providers.
• Maintain continuous, effective, positive, and appropriate communication as a way to prevent risk for the organization.
• Desire to read clinical documentation to accurately assign diagnosis code specificity for severity of illness to report disease burden to CMS via diagnosis codes meeting all documentation requirements as part of risk mitigation and risk prevention.
• Actively participate in all applicable meetings, webinars and or communications as a way to remain updated on any diagnosis coding rules and/or documentation changes from appropriate credible sources for accurate diagnosis coding and clinical documentation rules in addition to independently seeking CEU’s if needed to maintain credentials with the AAPC/AHIMA.
• Actively participates in site-level Quality Improvement Activities. Each employee will contribute to the continual evaluation site performance as well as the implementation and measurement of improvement activities that increase the quality of care provided to patients.
• Take accountability as a certified professional to review all clinical documentation
  ethically and thoroughly within the progress note(s) using all applicable tools and communications for capture of full disease burden.

EDUCATION:

• Associates degree, bachelors preferred with completion of college/accreditation level coursework in ICD-9-CM, ICD-10-CM and CPT coding, anatomy and physiology, and medical terminology.

EXPERIENCE:

• Experience with CMS Medicare Advantage Risk Adjustment Data Validation and HCC coding desired
• ICD-10 diagnosis coding experience in chart/progress note review.
• Risk adjustment, clinical documentation review for accuracy of diagnosis code assignment from a single code to several codes
• Health plan Risk Adjustment processes and system experience for CMS RADV and risk score assignment and acceptance are helpful.
• Must have proficient computer skills

CERTIFICATION/LICENSE:

•  Must hold a current credential for one of the following: RHIA, RHIT CCS, CCS-P, CPC, CPC-H, and/or CRC. If not CRC certified, you must attain the certification within the first year of your employment date.
• AHIMA/AAPC Certified Professional: Certification must be maintained by fulfilling the continuing education requirements and submitting current proof.

Summit Medical Group is East Tennessee’s largest primary care organization with more than 415 providers at 87 practice locations in 19 counties. Summit also consists of four diagnostic centers, mobile diagnostic services, eight physical therapy centers, four express clinics, central laboratory, and sleep services center. Summit provides healthcare services to more than 370,000 patients, averaging over one million encounters annually. For more information, visit www.summitmedical.com

In addition to our commitment to the health of our community, our organization is also committed to the health of our employees through our employee Wellness Program.  Employees receive a discounted monthly insurance premium if they actively participate in the wellness program. Pre-employment drug testing will occur prior to starting work and only candidates who pass the drug test will be considered eligible for employment.