Supervisor(a) De Codificación Clínica

MCS Health; San Juan (PR); On-site; USD 85,000 - 110,000; Full time

Job summary

MCS Health seeks a Health Information Manager to oversee CHRA post-payment audit processes, coding audits, and referral workflows. You will monitor timelines, coordinate audits, and guide personnel while ensuring adherence to industry regulations and company policies.

The role requires supervising staff, expertise in clinical coding (ICD-10-CM, CPT, HCPCS), and strong Microsoft Office proficiency. English and Spanish fluency preferred to support diverse healthcare operations in Puerto Rico.

Qualifications

• Bachelor’s degree in health-related areas with 4+ years in extraction of diagnoses/procedures and medical record interpretation.
• Experience supervising personnel for at least 1 year; healthcare industry exposure preferred.

Responsibilities

• Oversee CHRA post-payment audit process within established timelines.
• Coordinate second-level coding audits and monitor project execution.
• Ensure compliance of referral processes and distribution to appropriate units.

Skills

Supervising personnel

Educational presentations

Clinical coding knowledge

Education

Bachelor’s degree in health-related areas

Associate degree in Health Information Management Technology or 60 credits

Tools

Microsoft Office

Excel

PowerPoint

Word

Outlook

Job 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 Aff….”

MCS Healthcare Holdings, LLC. (MCS)is an Equal Employment Opportunity Employer and take Aff….