Job Description
Associate would be in charge of conducting Medical Records reviews to identify
HCCs (short-term insurance) that still haven't been submitted to CMS
(tools provided by the department). Collect the medical records that
support those findings upload in to our tool and code it.
Evaluates
and audits physician and hospital medical records and medical assessment
forms to ensure compliance with CMS guidelines and medical
documentation requirements. Responsible for serving as final auditing
arbiter regarding the Sr. Risk & Recovery’s Retrospective Risk
Adjustment (RA) Coding Team and responsible for the identification of
training opportunities for our internal and external stakeholders
related to CMS guidelines, HCC best practices and medical record
documentation requirements.
Essential Functions:
- Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
- Provides
regular feedback to Sr. Risk & Recovery leadership on performance
improvement opportunities as a result of performance gaps.
- Acts as a subject matter expert to internal and external stakeholders in the area of CMS requirements and HCC best practices.
- Participates
in and represents the department in business leadership groups,
including external professional groups specializing in coding and
provider education.
- Assists the business with research and documentation of workflows and policies and procedures.
Qualifications
- Must have Bachelor’s Degree in Health Sciences, Health Management, Nursing; or any combination of EDU/experience
- CPC or
CPMA (Medical Auditing Certification) from accredited source (American
Health Information Management Association, American Academy of
Professional Coders, or Practice Management Institute)
- At least 5 years of experience relevant to ICD-9 coding or medical record audit experience in a consultative role
- Experience developing educational materials and delivering trainings related to ICD-9 coding
Additional Information
Advantages of this Opportunity:
Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm
Company Description
With a 16-year tradition of excellence. A single source provider of world-class technology products and services for the healthcare industry. We are at the forefront of delivering cutting-edge, scalable technologies and solutions that respond to and anticipate the market's needs while providing sustainable value to our customers. Healthcare is our only business, giving us an unparalleled understanding of the volatile healthcare landscape. We take great pride in maintaining the highest levels of client satisfaction for the hundreds of U.S. hospitals and healthcare providers we serve. Our innovative products and services empower our customers to do what they do best – deliver outstanding patient care.