Population Health Coding Analyst

Job Description​

The Population Health Coding Analyst under minimal direction, independently and diligently reviews and supports the capture of correct coding including documentation improvement, provider education, analyzing reports, and identifying process improvements with an emphasis on Risk Adjustment and Quality Measure (CPTII) coding.

The Coding Analyst will assist healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation. The Coding Analyst will also work with payors on outliers, trending, analysis for improvement opportunities and strategies.

MINIMUM EDUCATION REQUIRED:

High School diploma or equivalent required.

Bachelor’s degree in related field preferred; and/or relevant equivalent and relevant work experience preferred.

MINIMUM EXPERIENCE REQUIRED:

1-2 years of general medical coding experience or clinical practice.

Recommended Experience

1-2 years of auditing experience and provider education

A minimum of 1 year HCC specific Coding.

CERTIFICATE/LICENSE:

Core medical coding credential: CPC, CCS-P, or CCS OR Clinical experience such as RN/LPN

CRC (Risk Adjustment) credential within 1 year of employment

Auditing credential: CPMA, CEMA, CPCO, or relevant experience

(Initial demonstration and maintenance of continuing education/membership is required).

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

None.

MAJOR JOB DUTIES:

Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines with an emphasis on Risk Adjustment.

The Coding Analyst will work with payors on outliers, trending, analysis for improvement opportunities and strategies.

Support physicians and APPs by providing education on documentation and coding as it relates to risk adjustment coding and population health strategies.

Provide feedback that will assist Population Health team with reporting valid HEDIS measures including CPTII coding with the goal of ensuring accurate, reliable, and publicly reportable data.

Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify whether:

· The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting.

· The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe.

· Any diagnosis code that is unsubstantiated by the record will need to be eliminated.

· Review for clinical indicators and query providers to capture the severity of illness of the patient.

· Performs on-site or electronic clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment and Managed Care Contract reimbursement initiatives.

· Communicates and coordinates reviews with physician office staff and distributes correspondence related to review.

· Educates and advises staff on proper code selection, documentation guidelines as well as assisting with training and education for new hires.

· Identifies training needs; prepares summary reports and conducts coaching as appropriate for clinicians and other staff to improve the quality of the documentation to reflect members’ health data.

· Conduct audits to abstract data not submitted by providers.

· And other duties as assigned.

SKILLS:

· Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology, and concepts of disease processes.

· Demonstrated ability to utilize a variety of electronic medical records systems.

· Ability to manage significant workload, and to work efficiently under pressure meeting established deadlines with minimal supervision.

· Strong time management skills.

· Must possess a high degree of accuracy, efficiency and dependability.

· Excellent written and oral communication for representation of clear and concise results

REPORTING:

· This position would report directly to Population Health Director

Job Requirements

Applicable Experience:

1 year

Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC), Cert Professional Coder - American Academy of Professional Coders (AAPC), Cert Professional Medical Auditor - American Academy of Professional Coders (AAPC)

Bachelor's Degree

Job DetailsFull Time

Day (United States of America)

The best place to get care. The best place to give care. Saint Luke’s 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke’s means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.

Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.

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