Senior Episode Coding Analyst at Signify Health
Senior Episode Coding Analyst
- Sr. Medical Coder, Episodes of Care
How will this role have an impact?
Signify Health is seeking a Senior Medical Coder to join our Episodes of Care team. We are looking for an individual who is an SME with expertise in clinical medical coding. This person will be responsible for completeness, appropriateness and accuracy of coding and documentation for Episode definitions, levers and quality measures for current and new episodes. They will also be responsible for developing and maintaining policies and procedures pertinent to coding and documentation of Signify episode definitions and derivative work. Additionally, this person will support company coding practices (code logic, code groupings, code libraries, testing) within Signify.
This role will report to: Director of Medical & Pharmacy Coding and Documentation
We are looking for someone with:
- Undergraduate degree in Healthcare Management, Healthcare Informatics, or other related fields. Will consider candidates with an Associate’s degree and significant experience in medical coding listed below:
- 3+ years of experience working as a medical coder in healthcare field. Medical Billing experience is desirable
- Must hold an active CPC, CCS, COC, CCS-P, CCA, or CPC-A good standing. CRC is desirable.
- ICD-10 Coding Certification
- Expert in medical claims coding (such as ICD, CPT, HCPCS, DRGs) and knowledge of Medicare HCC coding
- Advanced knowledge of medical terminology, medical taxonomy, abbreviations, anatomy, physiology, and major disease processes
- Experience with data mapping and standardization, and maintaining code lists
- Familiarity with Episodes of Care and Value-Based Payments methodologies
- Proficient in MS Office Suite, (experience with MS Access is a plus), and familiarity with Google Docs
- Detail oriented with high level of accuracy, problem solving, and strong organizational skills
- Passion for problem solving to identify disease concepts using medical coding data in novel ways
- Exceptional interpersonal and communication skills with ability to work effectively across geographically dispersed teams that represent diverse skillsets and backgrounds
- Self-directed, accountable, and proactive. Willingness to take ownership of projects and work with little supervision but also recognize when to reach out for guidance to ensure meeting timelines and project deadlines.
What will you do?
- Develop new code assignments, review existing codes for Signify episodes, identify gaps related to episodes of care definitions and create service modules to better classify groups within Signify episodes
- Review and assess for accuracy, completeness, specificity and appropriateness of medical codes for Signify episodes. Recommend improvement/changes as needed.
- Use advanced/specialized knowledge of medical codes and coding protocol to recommend what aligns with coding protocols for episode definitions, levers and quality metrics
- Maintain medical coding and work with Product and Analytics teams to update source of truth code library
- Support collaborative work with the internal team and with business partners to compare Signify’s episode definitions with national episode groupers such as PACES.
- Help develop new episode definitions based on client needs
- Integrate coding compliance standards into coding practices and report issues in a timely and effectively to manager, team and Product, and Analytics partners.
- Collaborate on projects including episodes of care derivative work development areas, e.g. substance use disorder, cancer, and kidney care, and drug codes to episodes of care definitions
- Contribute as a thought partner to our organization in understanding how physicians’ offices, hospitals, and payors approach billing of procedures and diseases and how this is related to episodes of care product development
- Demonstrate safe practices per corporate policy for security and privacy of any and all protected health information that may be accessed during normal work activities
- Maintain coding certification renewal and engage in continuous professional development
About Signify Health:
Signify Health is helping build the healthcare system we all want to experience by transforming the home into the healthcare hub. We coordinate care holistically across individuals’ clinical, social, and behavioral needs so they can enjoy more healthy days at home. By building strong connections to primary care providers and community resources, we’re able to close critical care and social gaps, as well as manage risk for individuals who need help the most. This leads to better outcomes and a better experience for everyone involved.
Our high-performance networks are powered by more than 9,000 mobile doctors and nurses covering every county in the U.S., 3,500 healthcare providers and facilities in value-based arrangements, and hundreds of community-based organizations. Signify’s intelligent technology and decision-support services enable these resources to radically simplify care coordination for more than 1.5 million individuals each year while helping payers and providers more effectively implement value-based care programs.
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