Value Based Care Coder Educator

University of Maryland Medical System

  • Linthicum Heights, MD
  • Permanent
  • Full-time
  • 9 days ago
  • Apply easily
Company DescriptionThe University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high-quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state’s future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System’s anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.Job DescriptionResponsible for abstracting medical record diagnosis codes based on clinical documentation, adhering to ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic guidance, CMS program regulations, and relevant federal and state laws, rules, and UMMS policies and procedures. Implement coding guidance for various programs, including Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, Commercial IVA (Initial Validation Audit), Medicaid HHS-HCC, Commercial DxCG, and OPPS (Outpatient Prospective Payment System) for claims reimbursement and medical necessity. Work is performed under limited supervision. Direct report to the Senior Manager, Risk Adjustment.Primary ResponsibilitiesThe following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed.
  • Perform code abstraction of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
  • Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education.
  • Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes.
  • Maintain knowledge of and ensure compliance with ICD-10-CM codes, CMS documentation requirements, and applicable federal and state, laws, rules and regulations.
  • Consistently maintain a minimum of 95% accuracy on coding quality audits.
  • Meet minimum productivity and quality requirements as outlined by the project terms.
  • Assist with individual and/or group education with healthcare providers as directed by the Senior Manager, Risk Adjustment.
  • Participate in developing, maintaining and meeting key performance indicators as defined in the
Risk Adjustment Project Plan annually.
  • Maintain and update the Risk Adjustment Project Plan annually.
  • Stay abreast of trends and regulations to ensure effectiveness and compliance of the Risk
Adjustment programs including CMS-HCC (Medicare), HHS-HCC (Medicaid), DxCG (Commercial) and OPPS (grouper methodologies).
  • Assist with quality assurance tools and processes.
  • Establish an understanding of the PHSO Risk Adjustment Project Plan and its interdependency on the PHSO Strategic Plan.
  • Participate and assist with preparation for meetings including but not limited to internal PHSO, payer, practice, etc.
  • Establish and maintain collaborative relationships with all levels of leadership, staff, and vendors.
  • Perform other duties as assigned.
QualificationsEducation & Experience - Required
  • Associate’s degree in healthcare, or related field, or the equivalent combination of education, training, and experience.
  • 3+ years’ experience in Medicare or Medicaid Risk Adjustment models (CMS-HCC, HHS-HCC, and DxCG risk adjustment methodology.
  • Experience with EPIC, Cerner and/or NextGen.
  • Certified Risk Coder certification from AAPC.
  • One of the following certifications from AHIMA or AAPC preferred: Certified Professional Coder
(CPC), Certified Coding Specialist (CCS or CCS-P).Education & Experience - Preferred
  • Not Applicable
Knowledge, Skills, & Abilities
  • Working knowledge of risk adjustment coding/billing/documentation workflows.
  • Working knowledge of healthcare metrics.
  • Advanced knowledge of the Affordable Care Act and its impact on Total Cost of Care and Value Based Care.
  • Ability to think strategically, understand functional structures, manage project work, and generate innovative and practical solutions to complex or unusual problems.
  • Advanced skill running, interpreting, and creating reports in Excel SharePoint, etc.
  • Advanced customer service and client facing skills.
  • Advanced skill developing and maintaining collaborative working relationships with all levels of leadership, team members and vendors.
  • Self-motivated individual who can excel with little supervision and the proven ability to be successful in a fast paced, dynamic environment.
  • Advanced skill presenting findings, conclusions, alternatives, and information clearly and concisely at all levels within the organization.
  • Ability to analyze, compare, contrast, and validate work with keen attention to detail.
  • Advanced analytical, critical thinking, planning, organizational, and problem-solving skills.
  • Keen sense of personal responsibility and accountability for delivering high quality work.
  • Advanced verbal, written, and interpersonal communication skills.
  • Advanced skill in the use of Microsoft Office Suite (e.g., Word, Excel, PowerPoint.).
Additional InformationAll your information will be kept confidential according to EEO guidelines.Compensation
  • Pay Range:$33.36-$46.7
  • Other Compensation (if applicable):
This is a fully remote position.Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at careers@umms.edu.

University of Maryland Medical System