Coding Associate

📋 Description

• • Join Intus Technologies, Inc., a pioneering force in healthcare technology, as a Coding Associate and play a pivotal role in revolutionizing care for seniors through our innovative IntusCare platform. IntusCare is the nation's only end-to-end ecosystem meticulously designed for Programs of All-Inclusive Care for the Elderly (PACE), empowering them to deliver unparalleled care, achieve robust financial performance, and maintain unwavering compliance. We are dedicated to replacing outdated systems and manual processes with sophisticated, purpose-built solutions that enhance care coordination, optimize risk adjustment, advance population health initiatives, and streamline utilization management. By joining our team, you will empower healthcare professionals to gain complete control over their operations, ultimately leading to improved health outcomes for dual-eligible seniors – a population characterized by significant social vulnerability and clinical complexity.
• • As a Coding Associate, you will be instrumental in delivering exceptionally high-quality and accurate risk adjustment coding services to our valued IRIS clients. This role is laser-focused on the intricacies of coding workflows, demanding a meticulous approach to reviewing medical records, precisely identifying diagnosis codes, rigorously validating documentation, and ensuring absolute adherence to the stringent standards set forth by CMS-HCC and risk adjustment regulations. Your expertise will directly contribute to the integrity of our clients' risk profiles and the effectiveness of their care strategies.
• • Key Responsibilities:
• • Risk Adjustment Coding Excellence:
• • Conduct thorough reviews of medical records to accurately assign all applicable diagnosis codes. This involves a deep understanding and consistent application of the ICD-10-CM Official Guidelines for Coding and Reporting, guidance from the AHA Coding Clinic, and IntusCare's internal IRIS coding policies and procedures.
• • Meticulously document clear and consistent coding rationales in strict accordance with IRIS standards, providing a transparent and auditable trail for every coding decision made.
• • Maintain an unwavering commitment to strict adherence to all CMS requirements, ensuring that our coding practices are always audit-ready and uphold the highest standards of risk adjustment integrity.
• • Quality & Compliance Assurance:
• • Consistently achieve and maintain a coding accuracy score of 95% or higher, demonstrating a profound commitment to continuous quality improvement and precision in every task.
• • Actively participate in internal audits, peer reviews, and periodic quality checks, contributing to a culture of shared learning and collective excellence.
• • Guarantee compliance with all relevant documentation requirements, CMS risk adjustment standards, and the rigorous expectations of RADV (Risk Adjustment Data Validation) audits.
• • Proactively identify and flag documentation inconsistencies or instances of incomplete provider documentation, escalating these critical observations for timely clinical review to ensure data accuracy.
• • Workflow Management & Productivity:
• • Efficiently complete assigned coding volumes, consistently meeting or exceeding established productivity targets. The expectation is for each Coding Associate to complete a minimum of 1000 encounters per month, showcasing a strong capacity for high-volume, accurate work.
• • Meet all critical deadlines for coding deliverables, ensuring the timely submission of data for client reporting and adherence to monthly operational cycles.
• • Leverage IntusCare’s proprietary IRIS tools, intuitive dashboards, and advanced platforms to execute coding tasks with maximum efficiency and accuracy.
• • Diligently follow structured workflows and promptly escalate any issues related to unclear or unavailable documentation to the appropriate channels, ensuring seamless progress.
• • Cross-Functional Collaboration & Communication:
• • Effectively communicate coding-related questions or suggestions for potential documentation improvements to the designated internal contacts, maintaining professional boundaries and adhering to communication protocols (direct communication with providers is not part of this role).
• • Actively participate in team meetings, fostering alignment on monthly cycles, staying abreast of product updates, and ensuring a shared understanding of evolving coding standards and best practices.
• • Contribute to a collaborative team environment where knowledge sharing and problem-solving are encouraged, enhancing the overall effectiveness of the coding department.