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Senior Clinical Analyst

1 month ago

Philadelphia, United States Independence Blue Cross Full time

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.The Sr Clinical Analyst reports to the Risk Adjustment Programs Manager in Government Markets. The key responsibilities of this role include:Responsible for analyzing member clinical charts, diagnosis data, CPT Codes, and any other diagnostic data for Independence's Medicare Advantage and Commercial HIX plans to assess chart coding accuracy and determine opportunities for improvement. The Sr Clinical Analyst will perform and participate in prospective chart coding reviews and recommend solutions to improve the quality and accuracy of clinical data for the Government Markets Unit. Responsible to identify and communicate trends in provider coding and documentation.The Sr Clinical Analyst will train new clinical analysts when hired, guide staff in the Population Health department with clinical Medicare/ACA Risk Adjustment and RADV procedures, policies, questions, and issues, will resolve clinical risk adjustment problems, and provide the department with clinical guidance with respect to risk adjustment data validation policies, procedures, and processes. Provide clinical and coding guidance and recommend content to team members for provider education and communication materials.The Sr Clinical Analyst will also participate in various corporate wide projects that will drive the collection of clinical data. The Sr Clinical Analyst will also be involved in training providers on risk adjustment coding policies both virtually and on-location at provider offices.Recommend solutions that physicians and their staff can use to improve the quality and accuracy of clinical documentation.Responsible to maintain knowledge and understanding of HCC/risk adjustment, coding, and documentation requirements.Identify educational needs and disseminate clinical coding and documentation of best practices to provider offices.Advanced analytical, problem-solving, and strong written communication skills are highly recommended. Ability to persuade, negotiate and resolve issues. Ability to define complex clinical issues and determine solutions. Ability to advise management on clinical issues. Ability to lead and train others, especially junior clinical staff.Other duties as assignedQUALIFICATIONSRN licenseCPC (Certified Coding Professional) credential requiredCRC (Certified Risk Adjustment Coder) credential required. Required to obtain CRC within one year of hireMinimum 5+ years' experience in risk adjustment coding activities in a Medicare/ACA or provider organization to include RAPS, EDPS, RADV Audits and all CMS/HHS, and other regulatory Guideline required. Expert knowledge of risk adjustment, Hierarchical Condition Category (HCC), medical terminology and medical chart review required. Demonstrated ability to research, analyze and interpret CMS coding and documentation guidelines and apply to chart review, coding, and auditing.Experience in coding guideline and policy implementationKnowledge of ICD-9 / ICD-10 diagnosis and procedure codes, CPT codes, Revenue codes, and HCPCS codesDisplays ability to function independently and can work cooperatively with other as part of a team. Strong verbal and written communication skills.Excellent organizational and planning skills.Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.Equal Employment OpportunityIndependence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.