Job Description

Job Description

Job Description

McGregor PACE (Program of All-inclusive Care for the Elderly) is a community-based service program that provides in-home healthcare services to the elderly as an alternative to nursing home placement, allowing Seniors to remain at home.

We seek a highly motivated and dedicated Medical Coder to join our team at PACE. As a Medical Coder , the primary goal of this role is to facilitate the accurate billing of services rendered, which directly impacts the financial health of the healthcare facility as well as stay updated on coding guidelines and regulations to ensure compliance and minimize the risk of audits.

THIS IS A REMOTE POSITION!

Responsibilities:

• Reviews, analyzes and codes diagnostic and procedural information to determine Medicare, Medicaid, and private pay insurance payments
• Analyzes and works in conjunction with physicians to affirm medical information is translated and properly coded to ensure the final diagnoses as stated by the physician are valid and complete
• Code physician assessments and encounters for RAPS submission completed by TPA
• Work with TPA to resolve RAPS coding errors and ensure all encounters are being uploaded to CMS monthly
• Create Redaction files as necessary for CMS upload
• Perform monthly coding audits to ensure accurate data submission to CMS
• Every month work coding audits and other encounter reports obtained from outside Consultant
• Responsible for special coding projects, together working with the consultant, to increase risk scores and impact reimbursements
• Work with the Quality Assurance Director related to coding of hospitalizations for Database II reports for CMS.
• Adheres to HIPAA, and Confidentiality policies and procedures in the performance of duties
• Assist with Truehart setup issues as necessary
• Performs other duties as assigned by the Controller

Qualifications:

• Certified Medical Coder with AAPC or AHIMA
• Three to five years experience in managed care/long-term care or hospital environment
• Proficiency in Microsoft Office software required
• Effective communicator, strong organizational skills with attention to detail
• Access to high-speed internet

Preferred Qualifications:

• Associate degree in accounting preferred
• Certified Risk Adjustment coder is strongly recommended.

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