Lead Medical Risk Coder

LEAD MEDICAL RISK CODER

Our Culture: Why work with us?

Joining Outer Cape Health Services isn't just about taking on a new role; it's about embracing a mission that goes beyond the day-to-day. Here, you become part of a dedicated team committed to safeguarding and nurturing invaluable community health resources. Our ethos is built on creating a vibrant and inclusive workplace where every team member is valued and recognized for their unique contributions.

Who We Are :

Our mission is to provide a full range of primary health care and supportive social services that promote the health and well-being of all who live in or visit the ten outermost towns of Cape Cod.

OCHS now cares for more than 18,000 patients annually, and no one is denied access to services due to an inability to pay. Founded in 1987 through the merger of Health Associates of Provincetown (established in 1972) and the AIM Medical Center in Wellfleet (established in 1966), Outer Cape Health has a long history of successful growth and expansion in pursuit of this mission. As a Patient-Centered Medical Home, OCHS holds itself to the highest standards. Ensuring patients have access to care when they need it and request it, and validating that staff are working at the top of their licensures, are foundations of this model.

Our Core Competencies:

At Outer Cape Health Services, our core competencies are the foundation upon which our organization is built, guiding us in our mission to deliver exceptional health services to our communities. Our focus on fostering teamwork ensures that we operate as a cohesive unit, valuing each member's contribution and working synergistically towards common goals. Integrity and honesty stand at the heart of everything we do, creating a culture of trust and respect among our team and the communities we serve. Embracing technology, we continually seek innovative solutions to enhance our services and operations. Finally, being patient-centered, we prioritize the needs and well-being of those we serve, striving to exceed expectations and make a meaningful difference in their lives.

A day in the life of this role:

The Senior Risk Medical Coder at Outer Cape Health Services ("OCHS") is responsible for creating and submitting medical claims, remaining current on coding requirements, and maintaining patient accounts by performing all billing functions. This is a supervisory role and excellent leadership skills are required.

Summary of duties:

• Create and submit patient medical claims through an electronic intermediary.
• Identify, collect, assess, report, monitor and document claim and encounter coding information as it pertains to Hierarchical Condition Category (HCC) codes and Risk Adjustment.
• Concurrent review of patient medical records to ensure accurate charges have been entered.
• Remain current on coding requirements, and act as a resource, to health care providers, practice and department managers and staff to resolve documentation, charge, or other issues as they arise to ensure accuracy of coding and reimbursement.
• Adhere to government requirements, industry standards, operational policies and procedures and organizational compliance objectives.
• Maintain patient accounts and performing all billing functions.
• Completing CEU requirements based on coding credential.
• Collaborate with the Director of Revenue Cycle in revenue cycle improvement objectives including ensuring compliant coding and billing, improving net revenue, improving charge capture process, ensuring EPIC integrity, and supporting and educating practices providers on charge capture best practices and process changes.
• Maintain current understanding of clinical procedures, patient charge protocol and regulatory requirements with charge system process.
• Perform audits of CPT and diagnosis code assignments to ascertain that clinical and diagnostic procedures are accurately coded, that this information is accurately passed to the billing system.
• Report results recommending corrective actions if needed and assist in recommending quality improvement programs.
• Communicate with the Director of Revenue Cycle to keep abreast of potential risk exposure related to coding and/or documentation practices by providers and/or coding personnel.
• Review specified medical records and corresponding claims for accuracy and completeness based on government requirements, industry standards, operational policies and organizational compliance objectives.
• Enter routine charges and changes into the EPIC billing system; research billing and coding requirements for new procedures that are introduced and ensure additions and changes to comply with federal guidelines.
• Maintain knowledge of current trends within the healthcare industry to remain cognizant of pending changes that may impact current processes to enhance professional expertise.
• Work insurance denials, aging claims, requests and appeals with appropriate carrier.
• Attend monthly calls to carriers to work unpaid claims.

What we need from you:

• Associate degree in health care, business or related field
• Minimum of 5 years' experience in Coding, and 2 years Risk coding or a combination of both.
• Minimum of 3 years Accounts Receivable, or reimbursement specialist, medical practice experience, or the equivalent combination of education and experience required.
• Must have previous supervisory or leadership experience
• Must have PowerPoint experience
• Must be certified

AAP/EEO Statement Outer Cape Health Services is committed to a firm policy in favor of equal employment opportunity and will abide by all applicable state and federal regulations by not discriminating against any applicant or employee on the basis of race, religion, color, creed, sex, age, national origin, citizenship status, marital status, sexual orientation, gender identity and expression, disability or veteran status. Our commitment to equal employment opportunities shall include employment, upgrading, promotion, demotion, transfer, leaves or other absences from work, layoff, compensation and benefits, selection for training or other education, professional opportunities and conflict resolution.

It is also the policy of OCHS to take affirmative action to employ and to advance in employment, all persons regardless of their status as woman, minority or individuals with disabilities or protected veterans, and to base all employment decisions only on valid job requirements.

Please inform us of any necessary accommodations required during the application process and/or at any time during employment.