POSITION SUMMARY: Performs functions necessary for review, audit and follow up of chart reviews for the Hierarchal Condition Category (HCC) Coding Risk Adjustment process for GlobalHealth’s Medicare Advantage (MA) population. ESSENTIAL DUTIES AND RESPONSIBILITIES: · Conducts retrospective and prospective audits of HCC coding for GlobalHealth MA membership by review of coding, medical record documentation, Vitreos web application and billed claims in accordance with Centers for Medicare and Medicaid Services (CMS) to ensure HCC coding risk accuracy. · Retrieves, reviews and executes on reports for prospective review for assigned provider groups. · Reviews and executes on reports for retrospective review for assigned provider groups. · Responsible for ensuring accuracy on internal chart audits, continuously improving upon this skill · Develops and maintains a relationship with assigned provider groups to setup HCC coding audit reviews for GlobalHealth MA members and quality education for providers. · Follows ICD-10-CM Official Guidelines for Coding and Reporting along with CMS guidance and regulations. · Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. · Performs other duties as assigned. EDUCATION AND EXPERIENCE: · High School diploma or equivalent and one year of experience in medical coding, claims or billing required. · Certified Risk Adjustment Coder (CRC) Certification or ability to obtain within 6 months of hire required. · CPC, CCS, CCS-P, RHIA, or RHIT credential required. · Chart review experience preferred. · Valid state Driver’s License, reliable personal vehicle and proof of personal vehicle liability insurance required. KNOWLEDGE, SKILLS AND ABILITIES: · Strong knowledge of ICD-10-CM, medical terminology and disease processes · Strong knowledge of coding and reimbursement in Healthcare sector · Excellent verbal and written communication skills. · Ability to manage multiple projects at once and work to meet deadlines · Ability to navigate and abstract from various types of medical record documentation including paper and electronic records · Intermediate computer skills using MS-Word, Excel, and Outlook and electronic health records (EMR) · Must be professional in appearance, speech and conduct WORK ENVIRONMENT: · Office setting, desk job with majority of tasks performed on a computer · Occasional heavy lifting of medical records, moderate amount of driving to and from audit locations and carrying laptop computer necessary for work off site TRAVEL: Up to 50% of in-state travel required. SUPERVISORY RESPONSIBILITY: This position does not have any supervisory responsibilities. OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
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