Job Summary
Supports the implementation of initiatives to improving coding and documentation accuracy for HP2 providers. Provides disease-specific risk adjustment provider training that balances both clinical and coding/documentation focuses. Responsible for implementation of initiatives to improve documentation and coding accuracy. Regularly reviews provider medical records for accurate and complete documentation and coding following the coding education and training curriculum. Supports retrospective chart reviews as well as pre-visit planning and post visit coding.
Minimum Job Qualifications
- Licensure or other certifications: Certified Risk Adjustment Coder (CRC). Certifications. CPC a plus
- Educational Requirements: Associate Degree
- Minimum Experience: 3+ years of ICD-10-CM outpatient coding and provider query experience in internal medicine/primary care settings
- Other:
Preferred Job Qualifications
- Preferred Licensure or other certifications:
- Preferred Educational Requirements:
- Preferred Experience:
- Other:
Job Specific and Unique Knowledge, Skills and Abilities
- Strong knowledge of ICD-10-CM Coding Guidelines, E/M, CPT/HCPCS, CMS-HCC risk adjustment model, medical record review project management, encounter data management
- Demonstrated ability to work cross-functionally within corporate matrix environments
- Effective ability to collaborate and partner on complicated initiatives
- Excellent verbal and written communication skills
- Proficient with Microsoft Office applications (Word, Excel, Outlook, PowerPoint)
Essential Tasks and Responsibilities
- Reviews medical records in support or pre-visit planning and post-visit program for opportunities with complete and accurate documentation and coding
- Delivers provider training and education in a variety of formats based on need and internal initiatives. Such formats may include classroom style education, webinar, face to face or written content
- Regularly interacts with providers and clinical/administrative team members to enhance understanding of Clinical Documentation Improvement program goals in order to achieve Risk Adjustment strategic goals and initiatives
- Audits charts as part of the overall risk score improvement plan. Organizes findings to share with providers, leadership and others as deemed necessary
- Identifies chronic conditions for providers to review during patient visits
- Queries providers to ensure complete and accurate documentation and coding after patient visits
- Partners with providers and clinical/administrative staff to enhance understanding of Clinical Documentation Improvement program goals in order to achieve Risk Adjustment strategic goals and initiatives
- Maintains current subject matter expertise by attending professional meetings, seminars, and related continuing education events
- Collaborates with internal teams to assure project-specific goals are met