Clinical Coding Supervisor

MCS Puerto Rico; San Juan (PR); On-site; USD 60,000 - 90,000; Full time

Job summary

MCS Puerto Rico seeks an Operations Supervisor for CHRA units, retrospective projects, and clinical coding processes. You will ensure compliance with procedures across accrediting bodies, including Medicare, and oversee post-payment audits and coding review cycles.

Responsibilities include coordinating audits, generating performance reports, guiding staff, and implementing process improvements while maintaining adherence to policies and regulatory requirements.

Qualifications

• Bachelor’s degree in health-related areas and 4+ years in extraction of diagnoses/procedures and medical record interpretation.
• Associate degree in Health Information Management Technology or 60 credits with 4+ years in diagnostic coding and staff supervision.
• Certification in clinical coding (CCA/CCS/CCS-P) preferred; knowledge of ICD-10-CM, CPT-4, HCPCS.
• English and Spanish proficiency; willingness to communicate in both languages.

Responsibilities

• Oversees CHRA post-payment audit processes and timing.
• Ensures second-level coding audits are completed on schedule.
• Monitors referral processes and ensures timely completion of referrals.
• Reviews coding audit results and ensures corrective actions are implemented.
• Identifies risks and coordinates with IT for system fixes as needed.
• Prepares and delivers statistical reports related to the Scorecard within the established time.
• Supervises unit staff and enforces company policies and compliance.

Skills

Staff supervision

Process improvement

Auditing

Healthcare compliance

IT coordination

Education

Bachelor’s degree in health-related areas

Associate degree in Health Information Management Technology

Tools

Microsoft Office

PowerPoint

Excel

Word

Outlook

Job description

GENERAL DESCRIPTION: Responsible for the operation of the units that manage the Comprehensive Health Risk Assessment (CHRA), retrospective projects, and clinical coding processes. Guarantees compliance with established procedures following operational guidelines and rules established by the different accrediting agencies, such as Medicare.

Regular, Exempt. GENERAL DESCRIPTION: Responsible for the operation of the units that manage the Comprehensive Health Risk Assessment (CHRA), retrospective projects, and clinical coding processes. Guarantees compliance with established procedures following operational guidelines and rules established by the different accrediting agencies, such as Medicare.

ESSENTIAL FUNCTIONS:

• Oversees CHRA’s post-payment audit process, monitoring that the execution of the processes is carried out within the established time.
• Guarantees that the second-level coding audit of medical records is carried out in the established time, coordinating and monitoring the execution of the project.
• Oversees compliance with the referral process of operational processes, guarantees that they are distributed to the appropriate units, monitors their status, and ensures that the processes are completed to complete the referrals.
• Reviews the results of the coding audits performed by the Pre-Audits area in Premium Handling. Ensure that the findings are discussed with the employee and that the corrective action plan is completed where applicable. Submit the results to the Pre-Audits area.
• Identifies situations that may represent a risk in the fulfillment of the unit’s objectives, goals, and operational procedures, such as data entry errors, coding errors, production problems, and corrective action plans that Information Technology (IT) may need to implement as a result of the findings, to establish alternatives, and refer them to the management for evaluation and approval.
• Prepares and delivers statistical reports related to the Scorecard within the established time.
• Supervises the operational process for the generation of the deleted indicators referred to the Premium Management Pre-Audits unit.
• Reviews operational guidelines to make modifications and/or add new tasks, as applicable, and reports their recommendations to the management.
• Requests the IT Department reports, system access, and errors in apps, among others, and keeps a record of such requests and their status.
• Identifies opportunities to improve existing processes and/or applications to facilitate their execution.
• Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor’s degree in health-related areas. At least four (4) years of experience working in the extraction of diagnoses and procedures and interpretation of medical records, coding both inpatient and outpatient medical services, working in hospitals, medical offices, and insurance companies, among others; and facilitating educational presentations, preferably in the Healthcare Industry. At least one (1) year of experience supervising personnel.

OR

Education and Experience: Associate degree in Health Information Management Technology or sixty (60) credits equivalent to an Associate degree. At least four (4) years of experience in diagnostic coding, medical record review, clinical information extraction, medical terminology, and staff supervision, in a healthcare facility and/or medical office environment. At least two (2) years of experience supervising personnel.

“Proven experience may be replaced by previously established requirements.”

Certifications/Licenses: Certification in clinical coding, such as CCA (Certified Coding Associate), CCS (Certified Coding Specialist), or CCS-P (Certified Coding Specialist-Physician), is preferred. Other: Extensive knowledge in medical coding systems using the following classification systems: ICD-10-CM, CPT 4, and HCPCS, as well as the use of essential modifiers. Knowledge of Microsoft Office applications, PowerPoint, Excel, Word, and Outlook.

Languages:

Spanish – Intermediate (comprehensive, writing and verbal)

English – Intermediate (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”