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Risk Adjustment Coder, Hedis and Stars

3 months ago

Tampa, United States CareNu Full time

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing

When you become part of the CareNu Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing groundbreaking solutions for our clients' unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success

Job Summary:

- Performs medical record reviews prior to and following annual wellness visits and other identified visits to determine appropriate ICD-10-CM coding and billing and compliance with Medicare Risk Adjustment metrics.
- Document detailed chart audit findings including documentation errors, diagnosis errors as well as missed HCC opportunities in applicable audit tools on a daily basis.
- Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding.
- Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education.
- Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
- Facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness diagnoses.
- Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices.
- Responsible for educating providers and their staff on HEDIS and STARs measures.
- Establish relationships with providers and staff to foster ongoing collaboration for data collection efforts.
- Recommend workflow efficiencies to providers and their staff in an effort to improve HEDIS scores.
- Perform research, data entry and quality control on key data sources following prescribed guidelines/protocols, data entry and quality control on key data sources following prescribed guidelines/protocols in support of regulatory reporting requirements including: HEDIS, STARs, Risk Adjustment and other quality activities.
- Train providers and staff on health plan P4P incentive programs; track progress and make recommendations for success.

**This is a hybrid role that requires 3-4 days in the corporate office/week**

Qualifications:

- Bachelor’s Degree or equivalent combination of education and experience.
- 3-5 years quality and/or coding experience in the Managed Care or Medicare setting
- Working knowledge of HEDIS and STARs measures
- 2 or more years of supervising other staff
- Ability to clearly present written information and findings, concisely communicate concepts and make executive-level presentations.
- Strong and effective verbal and written communication skills to multi
- level audiences.
- Demonstrates good judgment, organization and prioritization skills and time management skills.
- Proven leadership with staff, projects, and management.
- Strategic thinking abilities and analytical skills.
- Detail oriented with problem-solving abilities.
- Exemplary interpersonal and customer service skills. Demonstrates professionalism, poise, tact, and diplomacy in interactions with others.

Competencies:

- Satisfactorily complete competency requirements for this position.

Responsibilities of all employees:

- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe the Company's health, safety and security practices.
- Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
- Use resources in a fiscally responsible manner.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the organizational, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advanced electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.

Leadership Success Factors:

- Communication. Express thoughts and ideas clearly. Adapt communication style to fit audience.
- Initiative. Originate action to achieve goals.
- Management Identification. Identify with and accept the problems and responsibilities of management.
- Judgment. Make realistic decisions based on logical assumptions, factual information and in consideration of organizational resources.
- Planning, Organizing and Controlling. Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocat