Risk Adjustment Coding Analyst- Quality-Hansen Site-Green Bay

Risk Adjustment Coding Analyst Come work where we specialize in you!

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Job SummaryAt Prevea Health the Risk Adjustment Coding Analyst will perform coding reviews of medical record documentation to ensure proper capture of CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement activities.

The Risk Adjustment Coding Analyst will also be responsible for education on HCC's as well as working with different insurance contracts to aid in closure requirements.

What you will doComplete thorough medical record reviews, identify and assist the provider to update the Active Problem List for accuracy (highest degree of specificity) by transitioning the less/unspecified diagnoses codes to the most accurate diagnosis and appropriate code specificity.Review records prior to scheduled appointments and accurately identify conditions not yet incorporated in the Problem List to address gaps in preventive services and support code transitions for greater specificity and accuracy.Conduct prospective and retrospective coding activities to capture conditions applicable to Medicare Risk Adjustment reimbursement activities while ensuring compliance with coding guidelines.Perform an audit of medical records on a routine basis to identify all appropriate coding based on CMS HCC categories.

Set up meetings with providers to review results of audit.Responsible for education to providers, keeping track of trends and identifying areas for improvement.

Communicate findings of Risk Adjustment Data Validation (RADV) audits as need.Advise Chief Quality Officer of trends in inappropriate utilization (under and/over) of the HCC process.Perform quality coding reviews for other lines of business as defined.Work with supervisor to clarify issues of concern, process requests and follow-up.

Education QualificationsAssociate's Degree in healthcare business services, healthcare administration, medical coding or related degree.

Required Experience Qualifications1-3 years 2 years’ experience in a healthcare setting.

Required2 years Experience in Hierarchical Condition Categories (HCC) Conditions Preferred Skills and AbilitiesThe nature of the work is extremely repetitive and detailed.

Keen attention to detail, strong focus and organizational skills are essential for proficient accuracy and efficient output and to meet scheduled timeframes and goals.Must have the ability to prioritize to meet deadlines .Self starter with the ability to work independently to achieve company goals.Experience performing data analysis and demonstrated ability to present data utilizing a variety of formats.Understanding of Risk Adjustment Models.Familiarity with Medical Record documentation, auditing and coding guidelines.Experience with electronic medical records, EPIC preferredFamiliarity with medical insurance claims process required.Basic understanding of ICD-10 codes Licenses and CertificationsCertified Risk Adjustment Coder (CRC) certification Upon Hire RequiredCertified Professional Coder (CPC) certification Upon Hire Preferred Physical DemandsSit - ConstantlyStand - OccasionallyWalk - OccasionallyDrive - RarelyClimb (Stairs/Ladders) - RarelyBend (Neck) - FrequentlyGross Manipulation (Hands/Arms) - ConstantlySquat - RarelyTwist/Turn (Neck) - FrequentlyTwist/Turn(Waist) - RarelyLift/Carry 0-10 lbs.

- OccasionallyLift/Carry 11-25 lbs.

- RarelyPush/Pull up to 10 lbs.

- RarelyPush/Pull 11-25 lbs.

- RarelyReach (Above shoulder level) - OccasionallyReach (Below shoulder level) - ConstantlySimple Grasping (Hands/Arms) - ConstantlyFine Manipulation (Hands/Arms) - ConstantlyGross Manipulation (Hands/Arms) - Constantly Working ConditionsNoise - Occasionally Hearing RequirementsHears Whispers < 3 feet - ConstantlyHears Whispers 3-8 feet - Constantly Vision RequirementsColor Discrimination - ConstantlyNear Vision (Correctable to Jaeger 2 or 20/40 binocular) - ConstantlyDistance Vision (Correctable to Snellen chart 20/40 binocular) - Constantly Prevea is an Equal Employment Opportunity/Affirmative Action employer.

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