Job Description :
This job knows and recognizes compliant HCC Coding and Quality/HEDIS documentation in patient encounters. Reviews ambulatory and inpatient medical charts in EHR or from scanned medical records for prospective and retrospective coding of chronic conditions which map to HCCs, continues self-education to stay abreast of CMS updates, ICD10 Coding Guidelines and HEDIS measures. Recommends and implements process improvements related to HCC Coding and Quality/HEDIS care gap closures.
- Review medical charts for prospective and retrospective coding of chronic conditions which map to HCCs, and necessary quality of care measures to close care gaps which improve STAR ratings.
- Know and recognize compliant HCC Coding and Quality/HEDIS documentation in patient encounters.
- Continue personal education to stay abreast of CMS updates and ICD10 Coding Guidelines.
- Recommend and implement process improvements related to provider capture and completion of HCC Coding and Quality/HEDIS care gap closures.
- Other duties as assigned or requested.
- High School Diploma or GED
- 2 years of combined experience in Coding and Quality/HEDIS
- Registered Nurse (RN)
- 5 years of experience in HCC Coding and Quality/HEDIS knowledge
LICENSES AND CERTIFICATIONS
- Licensed Practical Nurse (LPN) or Registered Nurse (RN)
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
- Certified Risk Adjustment Coding Certification (CRC)
- Excellent verbal communication skills and professional manner, excellent written communication skills and a familiarity with a variety of writing styles
- Must be able to communicate with internal team members and management on monitoring and coding and quality improvements
- Demonstrated computer literacy and knowledge of information systems and comparative data bases. Working knowledge of Microsoft Office software (Word, Excel, Access, PowerPoint, etc.)
- Well-developed, analytical and problem solving skills with the ability to understand and interpret clinical data
LANGUAGE REQUIREMENT (other than English)?
0% – 25%
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Teaches/Trains others regularly
Travels regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (Sales employees)
Physical Work Site Required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Referral Level Payout 1
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