Certified Medical Coder (Hybrid)

Reviews, resolves, and responds to requests for corrections to previously processed claims and provider grievances that alter the application of benefits or pricing. Support and aid in the processing and review of Prosano Health encounters to payer. Additionally, this role will be responsible for conducting analysis, education, and training on medical and clinical diagnoses, procedures, and other activities to translate to appropriate coding designations.

REQUIRED QUALIFICATIONS

Required Work Experience

• 4 years of experience in healthcare related field

Required Education

• High-School Diploma or GED in general field of study

Required Licenses

• N/A

Required Certifications

• CCS Certified Coding Specialist or CPC Certified Professional Coder or CCA Certified Coding Associate Certification
• And CRC Certified Risk Adjustment Coder Certification

Preferred Work Experience

• At least 2 years of value-based medical, quality, and diagnostic coding in outpatient/primary care settings

• Associate's Degree in general or healthcare related field of study

• N/A

• N/A

• Support Provider Training and Education on coding standards and workflows (ex. HCPCS CPT-4, ICD-10, HCCs, CPT-2 best practice and tips)
• Consult on the configuration of Prosano Healths EMR to maximize coding efficiencies.
• Present trainings on site at Prosano Health locations
• Prepares coding 1 pagers, education materials, and content to support department performance.
• Reviews, researches, and corrects claims/encounter errors and processing issues, rejections, etc.
• Maintains effective communication with internal and external customers. Prepares written correspondence to explain results of error reviews.
• Maintain complete and accurate records per department policy.
• Ensures that the code assignments are supported by documentation, within the body of the medical records.
• Meet quality, quantity, and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
• Demonstrate ability to apply plan policies and procedures effectively.
• Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
• Participate in continuing education and current developments in the fields of medicine.
• Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
• Demonstrate ability to work in fast-paced environment and prioritize effectively where multiple work demands and projects may be present simultaneously.
• Provides prompt follow up with clinicians when additional documentation or queries are generated and required to close out coding activities.
• Attain/Maintain relevant professional certifications and continuing education to support as required

• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.