Senior Clinical Data Analyst

4 weeks ago


Philadelphia, Pennsylvania, United States Independence Blue Cross Full time
Senior Clinical Data Analyst

Bring your expertise in clinical data analysis to Independence Blue Cross as a Senior Clinical Data Analyst. In this role, you will be responsible for analyzing member clinical charts, diagnosis data, and CPT codes to assess chart coding accuracy and identify opportunities for improvement.

Key Responsibilities:
  • Analyze member clinical charts and diagnosis data to assess chart coding accuracy and identify opportunities for improvement.
  • Perform and participate in prospective chart coding reviews and recommend solutions to improve the quality and accuracy of clinical data.
  • Identify and communicate trends in provider coding and documentation.
  • Train new clinical analysts and provide clinical guidance to staff on risk adjustment data validation policies, procedures, and processes.
  • Provide clinical and coding guidance and recommend content for provider education and communication materials.
  • Participate in various corporate-wide projects to drive the collection of clinical data.
Qualifications:
  • RN license
  • CPC (Certified Coding Professional) credential required
  • CRC (Certified Risk Adjustment Coder) credential required
  • 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 and apply to chart review, coding, and auditing

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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