Job description

ESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to the following functions.

• Develop and monitor group specific HCC improvement plan for each physician group

• Develop tools for improved accuracy of coding and documentation

• Analyze payment policy and coding applications that have financial and operational impact associated with risk adjustment coding

• Ensures project activities are in compliance with applicable coding guidelines, government and federal regulations.

• Reviews and audits medical records at provider offices/clinics to identify coding risk areas and ensure that training activities are addressing these areas.

• Review records for completeness, accuracy and compliance with regulations.

• Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding.

• Using independent judgement and sensitivity, review with individual physicians and clinic administrators their audit findings and make suggestions for coding improvements.

• Provide written documentation of potential HCC codes to providers at the point of care while ensuring accuracy of coding and documentation.

• Resolve or clarify codes or diagnoses with conflicting, missing or unclear information by consulting with providers.

• Provide expertise in reviewing and assigning accurate medical diagnosis codes for a wide variety of clinical cases based on services performed by physician and other qualified healthcare providers in the office or clinic setting.

• Demonstrate sound knowledge of medical coding guidelines and regulations to assist providers and clinic administrators the impact of diagnosis coding on risk adjustment payment models.

• Maintain a professional and supportive working relationship with clinic staff, health plan staff, administration and physicians.

• Demonstrate high level of proficiency with documentation review including review of orders/results for lab, imaging, hospital records, EHR, etc. as a possible source for HCC codes.

• Participate in meetings as requested in order to establish and maintain interdepartmental and external partner communication and cooperation.

• Identifies training needs; prepares training materials and conducts coaching and training as appropriate for clinic staff, physicians and other staff to improve the quality of the diagnosis documentation and accuracy of the collection and coding of members’ health data.

• Performs miscellaneous job-related duties as assigned and requested.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

• At least 3+ years of HCC Coding experience

• Requires knowledge in HCC Coding documentation guidelines.

• Requires technical expertise in ICD-10-CM.

• Knowledge of functional code level II and medical terminology.

• Regulatory requirements for coded data.

• Understanding of healthcare data systems.

• Certification required in CPC and/or CCS

• Knowledgeable in Hierarchical Condition Categories (HCC) concepts and documentation guidelines.

• Must have experience using the practice management system of an electronic health system. (IMS preferred)

SKILLS

• Strong skills in medical record audit and review.

• Ability to work independently in a fast-paced remote environment with minimal supervision and guidance

• Strong proficiency with Excel--must have ability to prepare spreadsheets.

• Ability to work under pressure and in time sensitive situations.

• Ability to handle multiple tasks and be highly organized and detail-oriented

• Understanding of community based organizations

• Knowledge of CPT and ICD10 codes.

• Experience at Federally Qualified Health Center required

• Must have accuracy, excellent analytical, problem-solving, and time management skills, and possess strong organizational skills.

• Communicate effectively with providers, other staff and outside vendors.

• Knowledge of all programs offered by CNHF.

• Promotes and believes in CNHF mission statement.

• Ability to relate to the public regardless of ethnic, religion and economic status.

• Must have a high level of accuracy, excellent analytical, problem solving and time management skills, and possess strong organizational skills.

• Ability to adapt to changes in clinic setting and insurance payors requirements.

POLICY

Punctual and regular attendance is an essential responsibility of each employee at CNHF. Employees are expected to report to work as scheduled, on time and prepared to start working. Employees also are expected to remain at work for their entire work schedule. Late arrival, early departure or other absences from scheduled hours are disruptive and must be avoided.

This policy does not apply to absences covered by the Family and Medical Leave Act (FMLA) or leave provided as a reasonable accommodation under the Americans with Disabilities Act (ADA). These exceptions are described in separate policies.

WORK ENVIRONMENT

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 qualified individuals with disabilities to perform the essential functions. Variations in conditions may occur under certain circumstances.

CONFIDENTIALITY

Maintains patient, employee and Foundation confidentiality at all times, discussing patient or employee business only with appropriate parties who have a bona fide need to know; and communicating only the minimum amount of information necessary with respect to protected health information (PHI) as defined by the Health Insurance Portability and Accounting Act of 1996 (HIPAA).

Job Type: Full-time

Pay: $25.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Associate (Preferred)

Experience:

• Medical coding: 1 year (Preferred)
• ICD-10: 1 year (Preferred)

Work Location: One location

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