Position Summary:
To successfully monitor and implement clinical coding strategies. Audit documentation and coding practices to ensure accuracy in the data provided to CMS. Provide coding expertise as well as administrative oversight to ensure successful integration of AHC’s HCC initiatives.
General Duties/Responsibilities:
* Monitors coding & abstracting quality by conducting &/or coordinating ongoing audits to ensure coding quality & performance improvement standards are maintained, achieved & improved.
* Track and report progress of the audits performed on the coding vendors in order to assure the coding accuracy and quality of the data submitted to CMS.
* Develop, implement, evaluate & improve IPAs educational tools for their respective providers in order to accurately capture acute and chronic conditions.
* Tracks & reports progress of the audits performed on the coding vendors in order to assure the coding accuracy and quality of the data submitted to CMS.
* Work with Risk Adjustment Management on any Data Validation and /or RADV coding audit to ensure completeness and coding accuracy of all submissions to CMS.
* Maintain a comprehensive tracking and management tool for assigned IPAs within Alignments Healthcare provider network.
* Ensures compliance with all applicable federal, state &local regulations, as well as with institutional/organizational standards, practices, policies & procedures.
* Develop implement annual audit and monitoring of network providers documentation practices.
* Work with management on the monitoring of HCC Corrective Action Plans as needed.
* Assist with CMS Data Validation activities, including suggested record selections, tracking and submission, in conjunction with Risk Adjustment Healthcare Management.
* Regularly update all Risk Adjustment materials for clinical and official guideline changes.
* Update all education materials based on CMS-HCC Model and ICD-9/ ICD-10 annual changes.
* Suggest, update, and enhance clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMS-HCC Models, Clinician Chart Reviews, and Encounter Documentation.
* Suggest customizations of Risk Adjustment education for various audiences; Support Staff, PCPs, Specialists, Employees vs. contracted and Central Departments
* Stay current of industry coding, compliance and HCC issues.
* Utilize, protect, and disclose Alignment Healthcare patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
* Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
* Other duties as assigned to meet the organizations needs.
Minimum Requirements:
1. Minimum Experience:
1. Three-five years of coding in a medical group or health plan setting required; Professional Coding experience required.
2. Previous use of Epic, Allscripts, EZCap a plus
3. Proficient user in MS office suite, MS access a plus
2. Education/Licensure:
1. Bachelors degree in Business Administration, health Care Management or in a related field or equivalent experience desired.
2. Certified Coder required, CCS, CCS-P, CPC, Certified Auditor a plus.
1. Other:
1. Experience with strategic planning in risk mitigation.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
* The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
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