HCC Coding Specialist Population Health
Found in: Lensa US P 2 C2 - 2 weeks ago
Job Description
We are hiring a HCC Coding Specialist with Population Health This is a Monday through Friday day shift position based out of our Corporate Offices.
POSITION SUMMARY:
Under minimal direction, independently and diligently reviews clinical documentation and diagnostic results as appropriate to validate and ensure correct procedural and diagnostic coding of professional service rendered by clinicians, are in accord with documentation and coding guidelines for all patient services; inpatient, outpatient, ambulatory clinic, primary care, behavioral health, surgical and specialty clinics as documented in the medical records by the servicing provider. The Hierarchical Condition Category (HCC) Coder will assist healthcare providers in identifying and resolving issues related to incomplete or missing clinical documentation. The HCC Coder will also work with payors on outliers, trending, analysis for improvement opportunities and strategies.
MAJOR JOB DUTIES:
Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether:
• The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting.
• The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe.
• Any diagnosis code is unsubstantiated by the record and should be eliminated.
• Review for clinical indicators and query providers to capture the severity of illness of the patient.
Review all medical record documentation using the Healthcare Effectiveness Data and Information Set (HEDIS) to:
• Measure Providers’ performance on important aspects of care and service.
• Provide feedback that will assist Population Health team with reporting valid HEDIS measures with the goal of ensuring accurate, reliable, and publicly reportable data.
• Assess compliance with each HEDIS specification.
• Ensure the highest level of customer provider possible.
Support physicians and APPs by providing education on documentation and coding as it relates to risk adjustment coding and population health strategies.
The HCC Coder will also work with payors on outliers, trending, analysis for improvement opportunities and strategies.
ICD-10-CM Coding review for the following:
• The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting.
• The diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe.
• Any diagnosis code that is unsubstantiated by the record and to be eliminated.
• Review for clinical indicators and query providers to capture the severity of illness of the patient.
• Look for clinical indicators and query providers to capture the severity of illness of the patient.
• Performs on-site or electronic clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to
Medicare Risk Adjustment and Managed Care Contract reimbursement initiatives.
• Communicates and coordinates reviews with physician office staff and distributes correspondence related to review.
• The Certified Medical Coder educates and advises staff on proper code selection, documentation guidelines as well as assist with training and education for new hires.
• Identifies training needs; prepares summary reports and conducts coaching as appropriate for clinicians and other staff to improve the quality of the documentation to reflect members’ health data.
• Medical coder will conduct audits to abstract data not submitted by providers.
• And other duties as assigned.
SKILLS:
• Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease processes.
• Demonstrated ability to utilize a variety of electronic medical records systems.
• Ability to manage significant workload, and to work efficiently under pressure meeting established deadlines with minimal supervision.
• Strong time management skills.
• Must possess high degree of accuracy, efficiency and dependability.
• Excellent written and oral communication for representation of clear and concise results
REPORTING:
• This position would report directly to Population Health with dual reporting & responsibilities to Revenue Integrity Department, under the Physician Enterprise CBO.
MINIMUM EDUCATION REQUIRED:
High School diploma or equivalent required.
Bachelor’s degree in related field preferred; and/or relevant equivalent and relevant work experience preferred.
MINIMUM EXPERIENCE REQUIRED:
Three to five (3-5) years of general medical coding experience.
A minimum of 1 year HCC specific Coding.
Successful completion of a coding certificate program: CPC, CPC-H from AAPC or CCS-P, CCS from AHIMA. (Initial demonstration and maintenance of continuing education/membership is required). Certified Auditor (CPMA/CEMA) required.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None.
CERTIFICATE/LICENSE:
CPC/ CCS-P/ CCS and CPMA/CEMA
CRC preferred
Job Requirements
Applicable Experience:
3-5 yearsCert Professional Coder - VariousBachelor's Degree (Required)
Job Details
Full TimeDay (United States of America)
"The best place to get care. The best place to give care." That is the Saint Luke's vision and, whether in a hospital, clinic, practice, or office, our more than 12,000 employees strive toward that vision every day. Saint Luke's employees are proud of our rich history and heritage, and that we remain the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke's means joining a team of exceptional professionals who always strive for excellence in patient care. Take this opportunity to do the best work of your career within a highly diverse and inclusive work space where all voices matter.
Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer. We hire only non-tobacco users.
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