Medical Encounter Analyst
22 hours ago
- Conduct Root Cause analysis for encounter/HCC errors and initiate process improvement or communications to resolve future occurrence.
- Ability to reviews and analyzes medical documentation and diagnosis listed accurately reflects the care and treatment.
- Establish and maintain strong relationships with Health Plans, Encounter Clearing Houses, external auditors/vendors, and internal stakeholders to fix, prevent, and to obtain extra support in resolving encounter and HCC coding errors.
- Assigns a variety of diagnostic codes in ICD 10 CM with careful attention to the PACE HCC reimbursement model.
- Create daily and weekly reports highlighting the correlation of patterns, trends, etc.
- Bachelor’s Degree in Health Information Administration and two years of medical coding experience; or four years as a medical coder.
- One of the following Coding Certifications
- Certified Professional Coder
- Certified Coding Specialist
- Other AHIMA or CPC certification specific to HCC/Risk Adjustment Coding
- Read and understand complex medical record information and clarify diagnoses/procedures and sequencing of diagnoses as required.
- Clearly communicate medical coding related information to practitioners and others involved in the care or treatment.
- Analyze and resolve complex medical coding issues.
- Experience with eClinicalWorks (eCW) favored.
- Coding experience with a HCC Model is strongly preferred.
- Must maintain current coding credentials.
Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.
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