Data Integrity Specialist, ICD-10

🔥 8 minutes ago

🇺🇸 United States – Remote

💵 $65k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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ConcertoCare

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2015

⚕️ Healthcare Insurance

🏥 Healthcare

🌍 Social Impact

Healthcare Insurance • Healthcare • Social Impact

ConcertoCare is a healthcare provider that specializes in delivering in-home medical care and support services for seniors. Their mission is to enable elderly patients to maintain independence and quality of life by providing coordinated health services right in their homes. With a focus on both medical and social needs, ConcertoCare offers a range of services, including primary care, transportation assistance, food support, and palliative care, particularly for those with complex care requirements. As a risk-bearing provider, ConcertoCare emphasizes advanced analytics and virtual care technology to enhance health outcomes for vulnerable populations, ensuring that each patient receives tailored care that addresses their unique challenges.

📋 Description

• Review and ensure the accuracy, completeness, and compliance of risk adjustment coding for internal claim submissions • Conduct pre-claim, concurrent, prospective, and retrospective audits • Maintain compliance with CMS Risk Adjustment Methodology rules and coding/documentation guidelines • Monitor daily production volume and maintain a 95%–98% accuracy threshold • Process standardized risk adjustment encounters according to cases-per-hour expectations • Perform pre-claim audits and correct improper codes before claim submission • Validate diagnoses against clinical documentation and MEAT criteria • Ensure chronic conditions are actively managed during face-to-face visits • Identify and remediate unsupported, suspect, or inaccurately coded conditions • Identify trends, missed opportunities, and improvement areas through retrospective audits • Monitor performance using accuracy trends, audit results, and turnaround times • Collaborate with Clinical Documentation Improvement teams on provider education and documentation strategies • Maintain adherence to internal compliance policies and external regulatory requirements • Support internal, external, and health plan audit readiness, including RADV and plan audits • Analyze audit trends and inform the CDI Manager about risk areas and improvement strategies • Participate in risk adjustment strategy projects, prospective programs, and suspecting initiatives

🎯 Requirements

• Minimum 4 years of experience in ICD-10 Auditing • Current coding certification: CRC, CPC, or CPC-H required; CPC-As not accepted • High school diploma required • Bachelor’s Degree in Healthcare, Finance, or Business preferred • Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology • Advanced knowledge of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding • Knowledge of regulatory requirements and compliance standards • Proficiency in Microsoft Office Suite • Knowledge of coding and compliance standards • Knowledge of writing, grammar, spelling, punctuation, and sentence structure • Keyboarding and software skills for producing correspondence, charts, spreadsheets, and other applicable information • Analytical problem-solving orientation • Ability to manage multiple priorities • Demonstrated integrity, discretion, and maturity

🏖️ Benefits

• Annual bonus • Full healthcare coverage • 401K with match • Health, wellness, and financial benefits