Medical Coder

Description

EliteHealth is committed to bringing high quality healthcare in the Florida Market and is proud to be a part of the largest Senior Primary Care Organization in the country. We are partnering with our sister company, Conviva, for all of our career resources.

The EliteHealth primary care practices offer more services to patients than a traditional Doctor’s office by engaging its patients and making them an integral part of their own care. EliteHealth is able to focus on the prevention and treatment of chronic conditions. Its 360 Degree approach helps EliteHealth manage outcomes and the overall patient experience.

#EliteHealth

The Medical Coder extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

Responsibilities

The Medical Coder confirms appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight.

               

Responsible for reviewing medical records and identifying HCC conditions from the medical record using an electronic medical record system (EMR). Adheres to strict  ICD-10, CPT and documentation guidelines to assist in all coding and documentation audits and/or billing functions. Responsible for providing accurate diagnostic coding to help obtain timely reimbursement and ensure quality care of patients.

Essential job functions include, but not limited to the following tasks, they are:

• Follow most recent documentation and coding guidelines
• Uses only pre-approved source documents as validation for recommendations
• Queries providers on specificity of coding whenever there are any questions and clarifies all
• Assists is teaching any office staff and/or providers in proper documentation and coding guidelines as necessary.
• Reports any issues to the overseeing supervisory, as necessary
• Responsive to physician questions regarding area of expertise
• Submits claims to Payors either through a clearing house or through internal billings specialist
• Works claims denials and rejections
• Maintains professional knowledge and certification as MRA from an accredited governing body
• Ability to work well under pressure and manage time efficiently

Job Knowledge:

• Familiarity: Strong coding knowledge for documentation audits and guidelines for ICD-10.

• Detail Oriented and Work Under Pressure: Able to work with high volume of work while maintaining attention to detail and accuracy.
• English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. 
• Computer and Programs- Knowledge of computer hardware and software, including applications.  

Required Qualifications:

• Certified Medical Coder with one of the following certifications CPC,CPC-A, CPC-H or CPMA from AAPC or CCA, CCSP, CCS from AHIMA
• At least 2 years of experience as a Medical Coder
• Knowledge of billing practices and clinic procedures
• Knowledge of coding and clinic operating policies
• Proficient in CPT-4, ICD-9 and ICD-10 coding
• Minimum of one year of billing and coding experience in a health care organization.
• Ability to work Hybrid and travel to centers in the Miami Dade County and Broward County

Preferred Qualifications:

• 2 years of experience as a Certified Medical Coder with MRA experience
• Bilingual in English and Spanish

Additional Information:

Schedule: Monday – Friday 8:30 AM to 5:00 PM

Please Note: This is a Hybrid position. The Medical Coder will be required to report to the EliteHealth Pembroke Pines Center 3 days a week. You may have to also travel to the other EliteHealth Centers in Miami Dade and Broward County

Alert: 

EliteHealth, a subsidiary of Humana, values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.  

Interview Format: MODERN HIRE

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Please note:

Associates are required to be fully COVID vaccinated, including booster, or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home.

If progressed to offer, candidates will be required to:

• Provide proof of full vaccination, including booster OR
• Provide proof of applicable exemption including any required supporting documentation. Medical, religious, and state exemptions will be available

Scheduled Weekly Hours

40