Senior Clinical Data Analyst
6 hours ago
At Independence Blue Cross, we're committed to delivering exceptional healthcare services to our members. As a Senior Clinical Analyst, you'll play a critical role in ensuring the accuracy and quality of clinical data for our Medicare Advantage and Commercial HIX plans.
Key Responsibilities:- Analyze member clinical charts, diagnosis data, and CPT codes to assess chart coding accuracy and identify opportunities for improvement.
- Participate in prospective chart coding reviews and recommend solutions to enhance the quality and accuracy of clinical data.
- Identify and communicate trends in provider coding and documentation.
- Train new clinical analysts, guide staff in the Population Health department, and provide clinical guidance on risk adjustment data validation policies and procedures.
- Provide clinical and coding guidance to team members and recommend content for provider education and communication materials.
- Participate in corporate-wide projects to drive the collection of clinical data.
- Develop and implement solutions to improve the quality and accuracy of clinical documentation.
- Maintain knowledge and understanding of HCC/risk adjustment, coding, and documentation requirements.
- Identify educational needs and disseminate best practices to provider offices.
- 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 5+ years' experience in risk adjustment coding activities in a Medicare/ACA or provider organization
- Expert knowledge of risk adjustment, Hierarchical Condition Category (HCC), medical terminology, and medical chart review
- Demonstrated ability to research, analyze, and interpret CMS coding and documentation guidelines
- Experience in coding guideline and policy implementation
- Knowledge of ICD-9/ICD-10 diagnosis and procedure codes, CPT codes, Revenue codes, and HCPCS codes
- Strong verbal and written communication skills
- Excellent organizational and planning skills
Independence 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.
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