POSITION SUMMARY

The Medical Chart Reviewer is responsible for assessing coding selections to verify practice providers are coding properly based on their documentation. This position prepares provider scorecards that identify opportunities in coding encounters. Additionally, the Medical Coding Review provides education coding best practices and guidelines. 

This position is non-exempt and reports to the Claims Manager.

Essential Functions

• Responsible for conducting internal assessments of coding accuracy, policies and strategies based on documentation
  • Generate reports and audit patient records
  • Prepare scorecards based on findings during coding review
• Provide education to internal clinicians on proper coding guidelines and documentation
• Create, update and access confidential patient information while adhering to HIPAA guidelines
  • Perform routine data entry into various software systems
  • Answer or return calls
  • Add information to appropriate software resource
• Meet (or exceed) department metrics for outreach and scheduling activities, assisting in the preparation of reports for tracking purposes; Tracking and providing patient related data as needed
• Other duties and special projects as assigned

Education and Experience Requirements

• High school diploma or equivalent
• Certified Professional Coder (CPC) in good standing with AAPC
• Minimum 5 years progressive professional coding experience with extensive knowledge of ICD-10 and CPT codes assignment, principles and guidelines, reimbursement systems, and federal, state and payer-specific regulations and policies relating to documentation, coding, and billing
• Ability to communicate effectively orally and in writing, demonstrating professional writing skills
• Knowledge of, and ability to use, electronic record keeping systems (EMR, billing software, insurance carrier portals, spreadsheets, etc.)

Tools and Equipment Requirements

·        The ability to use a phone, computer, printer, and copier is required

• Must have superior computer skills and demonstrate proficiency in the use of productivity software (MS Office) and electronic medical record (EMR) systems

·        The ability to use the internet and various web browser software is required

Physical Working Conditions and Office Setting Description

• This position may be remote, hybrid or in-person based on the assigned department’s business needs.
  • If designated as hybrid or remote, the availability of virtual workdays is subject to change based on business needs

·        Some travel required to field locations to facilitate execution of responsibilities may be required; Must be able to travel to locations other than primary worksite

o   Driver’s license and valid insurance may be required when operating a personal vehicle