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Clinical Data Analyst

1 month ago

Philadelphia, Pennsylvania, United States Independence Blue Cross Full time
Job Summary

We are seeking a highly skilled Clinical Analyst to join our team at Independence Blue Cross. As a Clinical Analyst, you will play a critical role in analyzing member clinical charts, diagnosis data, and CPT codes to assess chart coding accuracy and identify opportunities for improvement.

Key Responsibilities
  • Perform and participate in prospective chart coding reviews to recommend solutions for improving the quality and accuracy of clinical data.
  • Identify and communicate trends in provider coding and documentation to inform quality improvement initiatives.
  • Collaborate with the Sr. Clinical Analyst to guide staff in the Population Health department on clinical Medicare/ACA Risk Adjustment and RADV procedures, policies, and issues.
  • Participate in various corporate-wide projects to drive the collection of clinical data.
  • Develop and deliver training programs for providers on risk adjustment coding policies and best practices.
Requirements
  • RN license
  • CPC (Certified Coding Professional) credential required
  • CRC (Certified Risk Adjustment Coder) credential required, with the ability to obtain within one year of hire
  • Minimum 3+ years' experience in risk adjustment coding activities in a Medicare/ACA or provider organization
  • Strong knowledge of risk adjustment, Hierarchical Condition Category (HCC), medical terminology, and medical chart review
  • Ability to research, analyze, and interpret CMS coding and documentation guidelines and apply to chart review, coding, and auditing
What We Offer

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.

This role is designated as a hybrid model, with Associates working in the office 3 days a week and remotely 2 days a week. The work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.