Bilingual/Spanish Certified Medical Coder II

Bilingual/Spanish Certified Medical Coder II
Associate III - BPM

Who We Are:
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members' well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.

We have a strong global presence and a dedicated workforce of over 4000 people spread across the world. Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

You Are:
The Bilingual/Spanish Certified Medical Coder II will perform retrospective coding and prospective CDI Opportunity Review to assist healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation. The Coder II will conduct audits to abstract data not submitted by providers and initiate opportunities to improve clinical documentation, accuracy, completeness, and compliance to enable providers to deliver the highest level of quality of care.

The Opportunity:
• Ensures compliance with all applicable Federal, laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System.

• Performs on-site medical record review to capture of all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system.

• Ensure diagnosis codes are supported by the documentation and ensure adherence with ICD-10CM Guidelines for Coding and Reporting.

• Focus on retrospective coding to close HCC gaps and add HCC codes not reported, including the prospective review and creation of CDI opportunities.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need:
• High School diploma or equivalent required. Bachelor's degree in a related field preferred.
• Successful completion of a coding license or certificates; CPC, COC, CRC, CPMA, or CCS-P. Continuous learning, as defined by the Company's learning philosophy, is required.
• EXPERIENCE: Minimum two (2) years HCC specific Coding.
• Clinical background preferred.
• Experience and understanding of CMS HCC Risk Adjustment coding and data validation requirements.
• Initial demonstration and maintenance of continuing education/membership is required.
• SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
• Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology, and concepts of disease processes.
• Extensive knowledge of ICD-10-CM coding guidelines.
• Advanced technical skills for use of MS Office (Excel, Word, Outlook, and PowerPoint)
• Demonstrated ability to utilize a variety of electronic medical records systems.
• Ability to manage a significant workload, and to work efficiently under pressure, while meeting established deadlines with minimal supervision.
• Must possess a high degree of accuracy, efficiency, and dependability.
• Excellent written and oral communication for representation of clear and concise results.
• Ability to read documents written in Spanish.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $49,000-$58,000

Benefits

Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company's 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.
Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) Retirement Plan with employer matching.
Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.
Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).
All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.
What We Believe
At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.
Guiding Principles
These principles illuminate the path of 'how' we operate. They detail actions and behaviours we much embody to honor our values and achieve our goals.
• Simplicity
Simplifying complexity underlines everything we do-this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.
• Integrity
Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.
• People-Centricity
Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.
• Leadership
Taking ownership is about taking initiative, being in-charge and driving things to completion. It's a brave choice to 'own' all aspects of our work, ensuring we take full responsibility for everything we handle.

Mission

A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more - their members' well-being.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and "fair chance" ordinances.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

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Skills
Healthcare,Medical Coding,Coding Practices