Our client, a leader in the healthcare industry, is looking for a HCC Coding Specialist to join their team!
Under the direction of the Director of Quality Informatics, the HCC Coding Specialist performs on-going chart review projects and activities assigned by the HCC Subcommittee and Director of Quality Informatics to improve HCC/RAPS reporting to CMS. This position is responsible for collecting, reviewing, validating, and submitting pertinent HCC diagnostic data from both internal and external sources. The HCC Coding Specialist collects information related to HCC reconciliation and assists in efforts aimed to maximize medical record documentation standards, coding standards, and Member Care. Develop measurement tools to report effectiveness of HCC reviews at the Provider level. Assist in identifying potential coding patterns and areas needed for providing educational outreach.
Major Functions (Duties and Responsibilities)
1. Performs ongoing HCC-related improvement projects assigned by the HCC Subcommittee or Clinical Informatics Manager to compile accurate and complete ICD-10 physician coding and maximize HCC results.
2. Conducts clinical chart reviews, perform audits, and on-site reviews using prioritized HCC target lists.
3. Analyzes claim and encounter data to identify incomplete or inaccurate ICD-10 coding patterns submitted at the physician level. Use this data to develop targeted educational outreach to physician offices.
4. Works closely with the HCC Subcommittee in identifying opportunities for HCC coding education and business strategies within the Provider Network.
5. Develops educational coding materials for use in provider education outreach activities.
6. Develops measurement tools to assess HCC data adequacy and identifying deficient coding patterns and provider educational needs.
7. Conducts provider training sessions related to proper HCC coding practices.
8. Demonstrate a commitment to incorporate LEAN principles into daily work.
Two (2) years of experience in HCC Coding. Must have strong chart audit experience in HCC coding. AHIMA or AAPC Certified Coder with experience in managed care, program/project management, data analysis and interpretation.
Experience in HCC Coding in an HMO setting is preferred.
High school diploma or GED required.
AHIMA or AAPC Certified Coder.
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license or Vocational Nurse (LVN) License issued by the California BRN.
Working knowledge of Centers for Medicare & Medicaid Services (CMS) HCC coding requirements, ICD-10 and CPT guidelines are required. Knowledge in the HCC-Risk Adjustment process and health insurance concepts as they relate to Medicare Advantage and Part D plans are required.