Job Description

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Certified Medical Coder is responsible for analyzing provider documentation to accurately select ICD-10 and CPT/HCPCS codes, ensuring compliance with coding guidelines, third-party reimbursement policies, and accreditation standards. This role involves performing coding duties for complex cases, including auditing, reporting, and collaborating with providers to address coding corrections and clarifications. The individual will distribute monthly audit reports, address any questions or concerns from providers, and offer training to staff on coding processes and requirements. Additionally, the role includes resolving discrepancies in coding, reviewing and correcting rejected claims from third-party carriers, and performing other coding duties as assigned by management to ensure accurate and timely submissions.

Skills Required:

• Minimum 2 years of risk coding experience, preferably in primary care or behavioral health
• Certification in Professional Coding (CPC) required; Certification in Risk Adjustment Coding (CRC) preferred
• High school diploma or GED required; Associate’s degree preferred
• Proficiency in Microsoft Office, especially Excel
• Strong understanding of ICD-10, CPT, and HCPCS coding systems
• Ability to work independently in a remote environment
• Strong interpersonal skills to build relationships with colleagues and external auditors
• Excellent written and verbal communication skills
• Ability to multitask and prioritize effectively in a fast-paced environment

Key Behaviors:

Attention to Detail: 

• Consistently ensures accuracy and thoroughness in coding and documentation.

Collaboration: 

• Works effectively with cross-functional teams, including providers and other staff.

Communication: 

• Demonstrates clear and professional communication, both written and verbal, with colleagues and external auditors.

Flexibility: 

• Adapts quickly to shifting priorities and changes in a fast-paced environment.

Problem Solving: 

• Takes initiative to resolve discrepancies and address challenges with coding or claims issues.

Accountability: 

• Takes ownership of tasks, ensuring deadlines are met and quality is maintained.

Competencies:

Technical Expertise: 

• Deep knowledge of medical coding, including ICD-10, CPT, and HCPCS systems, and an understanding of their application in a multi-state telemedicine and home-based care environment.

Compliance Knowledge: 

• Familiarity with coding guidelines, third-party reimbursement policies, and industry regulations to ensure adherence.

Training & Development: 

• Ability to educate providers and staff on coding requirements and to lead training sessions.

Time Management: 

• Efficient in managing multiple priorities and ensuring tasks are completed on time and with precision.

Customer Service Orientation: 

• Ability to maintain a high level of service and professionalism when working with providers and staff to resolve issues.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

Compensation details: 60000-65000 Yearly Salary

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