Clinical Coding Specialist

Title: Clinical Coding Specialist

Location: US National

Remote

Position Summary:

The Clinical Coding Specialist supports clients transitioning to value-based programs and troubleshoots lagging performance assisting in removing barriers. The Clinical Coding Specialist is a nurse and certified coder. They serve as an advisor and consultant on coding initiatives for internal and external stakeholders. This individual will create and review clinical content related to coding, perform coding audits for select clients, and train clients on accurate and complete coding. The role requires translating clinical, regulatory, and contractual language into actionable tactics that can be implemented in a physician’s practice.

Diversity and Inclusion are core values at Signify Health, and fostering a workplace culture reflective of that is critical to our continued success as an organization.

Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

• Audit accuracy, quality, and consistency of coded data by conducting audits of medical records, practice management systems, billing systems, and computer databases related to Medicare reimbursement
• Serve as a subject matter expert on topics such as CMS risk adjustment coding, Hierarchical Condition Category coding, best practices, and medical record review criteria.
• Train and facilitate educational events related to best practices in coding for audiences, including primary care physicians, nursing staff, administrators, coders, and billers.
• Coordinate with Delivery Team, Content Team & Product Team to develop, integrate, and maintain clinical coding content into our Approved Content library and Platform product functionality.
• Verify compliance with federal, state, and local laws, especially regarding Medicare coding and documentation guidelines. Synthesize complex information from multiple, sometimes conflicting, sources to form a conclusion.
• Research and resolve education content inquiries and provide training for internal and external stakeholders

Competencies: To perform the job successfully, an individual should demonstrate the following:

• Proficient and knowledgeable in ICD-10, ICD-9, CPT, HCPCS, and HCC Coding
• Demonstrates ability to provide training on documentation & coding in a way that engages multiple learners (physicians, nurses, medical assistants, practice administrators, office staff)
• The ability to evaluate medical records with attention to detail and to summarize findings
• Excels in public speaking and client engagement
• Ability to collaborate and meet demands of multiple stakeholders across departments
• Proficient planning and organizational skills.
• Calm and effective in a high-pressure, fast-paced, client-driven environment.
• Self-motivated and able to work independently and collaborate in a virtual environment while managing multiple deliverables with competing priorities.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Education/Experience:

• Current licensure as a Registered Nurse with a BSN (Bachelor of Science in Nursing) or equivalent degree
• Certified Coder credentials from a nationally recognized organization required (Ex: CMC, CPC, CCS). CRC certification is preferred.
• Minimum of five years of experience in billing, coding, and HCC in an ambulatory care setting
• Experience working with Accountable Care Organizations preferred
• RHC and/or FQHC coding experience a plus.