HCC Certified Coder

Position: HCC Certified Coder 

The Monogram HCC Certified Coder will abstract clinical information and assign appropriate diagnosis and procedure codes in accordance with nationally recognized coding guidelines. The HCC Certified Coder will analyze and translate medical and clinical diagnoses, in adherence with the CMS Risk Adjustment Models. The successful candidate will work as a team with our coding team and providers. Primary duties include auditing patient health assessment, peer coding quality reviews, provider and coding team training and education. Performs medical chart audits on prospective basis to identify, monitor and document claims and encounter coding information as it relates to Hierarchical Condition Categories (HCC). Performs coding abstraction and medical chart quality audits to ensure clinicians have accurate clinical documentation to support ICD-10 codes and are adhering to CMS Risk Adjustment guidelines. Educates clinicians on specific coding issues found in their charts and keeps them abreast of coding and documentation guidelines. 

Roles and Responsibilities 

• Maintains 95% coding accuracy rate   
• Maintains production goals   
• Experience working remotely with proven ability to prioritize tasks, meet goals and deadlines  
• Performs accurate and timely coding (CPT, ICD-9, ICD-10, HCPCS, modifiers).  
• Demonstrate advanced knowledge of medical terminology, anatomy, and physiology  
• Provides timely correspondence with providers regarding clinical documentation opportunities and queries. 
• Identifies trends through data analysis or chart review, reviewing existing policy for accuracy and developing new policies and recommends solutions to meet objectives.   
• Keeps abreast of mandated regulatory, documentation and coding guidelines to documentation, including demonstrated proficiency with all areas of CPT, ICD-10 and HCPCS coding. E/M code assignment, auditing, and education.  
• Performs quality audits, education, and training for coding team.   
• Works closely with leadership to create coding tools for coding team and providers.   
• Performs other duties as required or assigned  

Position Requirements  

• CPC, CCS, or CCS-P credentials, required   
• CRC credentials, required  
• 3+ years’ experience in Certified Coder role  
• 3+ years’ experience in HCC coding  
• Experience with Athena is a plus.  
• Experience with medical billing is a plus.   
• Experience coding Nephrology is a plus.  
• Must have proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Record   
• Experience communicating & working closely with Physicians  
• Experience in Medicare programs and regulations including fraud and abuse and Risk Adjustment  
• Familiar with STARs performance measures and metrics.  

Benefits 

• Opportunity to work in a dynamic, fast-paced and innovative value-based provider organization that is transforming the delivery of kidney care 
• Competitive salary and opportunity to participate in the company’s bonus program 
• Comprehensive medical, dental, vision and life insurance 
• Flexible paid leave and vacation policy 
• 401(k) plan with matching contributions  

About Monogram Health 

Monogram Health is a next-generation, value-based chronic condition risk provider serving patients living with chronic kidney and end-stage renal disease and their related metabolic disorders. Monogram seeks to fill systemic gaps and transform the way nephrology, primary care and chronic condition treatment are delivered. Monogram’s innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum. By focusing on increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing greater health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease. 

At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences. 

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