PMG Coder
: Job Details :

PMG CoderGuaynabo, PRABOUT USAt Grupo Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results.When you join Grupo Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.Let's build healthier communities together, join now! ABOUT THE ROLEResponsible for reviewing and supporting primary care physicians (PCP) to correctly and completely code healthcare claims, in order to obtain reimbursement from insurance companies and government healthcare programs, such as Medicare. Review medical records and claims data to ensure that assigned diagnoses and complications' codes are adequately documented, billed and reported by the PCP, meeting required legal and insurance rules. Also ascertain that required signatures and authorizations are in place prior to submission.WHAT YOU'LL DO•Visit primary care physician (PCP) review medical records, claims history, and other relevant information to accurately assign diagnosis codes (ICD-10-CM), focusing on Encounters and ePASS (Annual Health Risk Assessment). This to ascertain accurate and complete coding to be submitted by the PCP in the corresponding Encounters and / or ePASS (Annual Health Risk Assessment). •Evaluate medical record documentation to ensure that diagnostic and procedural codes accurately reflect and support the outpatient visit. Ensure that codes tally with doctors' diagnosis. Collect/ consult health information as documented by medical specialists and support PCP to code it appropriately. •Apply general and recent coding guidelines for reviewing process and regulatory knowledge to actively improve processes and efficiencies. Stay updated on coding guidelines, regulations, and industry best practices to enhance coding performance and achieve organizational objectives. •Obtain and disseminate updated documentation and coding audit guidelines according to accepted current coding and medical practice. Maintain accurate documentation and records of analysis, reports, and action plans for audit and reference purposes, ensuring transparency and accountability. Coordinate training, supporting, and developing employees, primary care physicians and staff. •Analyze patient charts meticulously to accurately translate diagnoses into specific codes, identifying coding opportunities and trends among PCPs and patients. Review coding opportunities, trends by primary care physicians and patients, and develop overall PCP work plan to meet goals and needs. •Provides support to audits requested by CMS, OIG, and Compliance or Internal Audit Department by reviewing medical records, determine the completeness, accuracy, coding and prepare the records for submission. Review and coordinate and/or conduct audits (either desk audit and/or field audits) of clinical documentation by assessing the level and accuracy/adequacy of coding and documentation of ICD-10 codes using CMS criteria. Present findings and recommendations to management, facilitating informed decision-making and strategic planning to enhance coding efficiency and accuracy. •Understand, develop, track, monitor, and report on key performance metrics for coding initiatives, ensuring alignment with departmental goals and objectives. Meet established metrics for productivity, accuracy, and compliance with departmental policies and procedures, contributing to overall program success. •Collaborate cross-functionally to implement improvement initiatives based on data analysis and performance metrics, fostering a culture of continuous improvement to ensure that CarePoint goals and expectations are met/exceeded. •Perform responsibilities of providing technical guidance to physicians in identifying codes that do not conform to the approved coding principles/guidelines. Promotes policies and procedures following recognized standards of care, accreditation, compliance standards and guidelines, and other evaluating entities, including state and federal agencies.WHAT YOU'LL BRINGBachelor's Degree in Business Administration or Health Science with one to three years of experience as a Medical Coder. Or Associate's degree in a related field with three to five years of experience as Medical Coder in lieu of. Certified Coding Specialist from American Health Information Management Association (AHIMA) or the American Association of Professional Coders (AAPC), preferable but not required.It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans . Employer with E-Verify to verify the eligibility of employment of all the new employees.We encourage Females, Veterans and Disabled to Apply