CPC/CCS/CRC Coding (Clinical Document Specialist ) - #126991 (New York City , NY)-not telecommute

Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
This position will be embedded at a local provider office in New York City. Associates who hold this role may have occasional travel to other local area provider offices as required.
Responsible for conducting retrospective medical reviews to assess medical record documentation and monitoring submitted codes on claim/encounters for Medicare Risk Adjustment. Primary duties include, but are not limited to: Conducts retrospective medical record and claims review to assess medical record documentation practices and accuracy/sufficiency of policies and procedures. Verifies accuracy/appropriateness of submitted diagnosis codes based on medical record documentation while looking at both ways 1) appropriate detail in the medical record is not captured in what is reported, and 2) when reported information is not supported by details in the medical record. Identifies and recommends coding best practices to address unsupported additions/deletions, inconsistencies/discrepancies. Collaborates with practice leadership to communicate opportunities and recommendations to practice staff. Educates physicians/other clinicians on proper documentation practices including specificity and appropriate sequencing/inclusion of diagnosis or procedures to more accurately reflect the acuity/severity and occurrence of events. Updates and develops policies and procedures and training/educating collateral to reflect best practices. Conducts on-going review, monitoring and communications to promote and ensure adherence to established protocols and best practices. Supports the practice in accurately coding/abstracting medical records per organization standards. Reviews documentation of well visits (annual well visits and other routine and preventative visits) including the use of appropriate modifiers for HEDIS scoring accuracy. Conducts on-going review of medical records/practice notes to validate improvement, identify any new/additional opportunities to improve medical record-keeping, code more accurately, ensure on-going accuracy of submitted codes and accurate risk scoring and continues to verify coding accuracy and completeness to ensure compliance.
Requires 2 years experience coding all types of medical records (including Medicare Risk Adjustment) in a physician practice setting or large group practice.
Current Certified Professional Coder certification in any of the following: (CPC, CPC-H, CCS, or CCS-P) or Certified Risk Adjustment Coder (CRC) required.
Additional experience in procedural clinical coding preferred. Clinical experience or background (e.g. RN, LPN, foreign medical graduates) preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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