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Medicare Risk Adjustment HCC Coding and Clinical Documentation A
Category: Banking, Health Care Industry , Insurance
  • Your pay will be discussed at your interview

Job code: lhw-e0-90646698

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  Job posted:   Thu Jun 7, 2018
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Medicare Risk Adjustment HCC Coding and Clinical Documentation A
Medicare Risk Adjustment HCC Coding and Clinical Documentation Analyst

This role is responsible for conducting retrospective, prospective and concurrent reviews for the Medicare Risk Adjustment organization to identify documentation improvement opportunities according to CMS and ICD-10 risk adjustment coding guidelines. In this role you will be working collaboratively with providers, coder, and/or office staff performing coding and review onsite. This role reports to the Coding Frontline Leader. Work will require 50% travel in your local market.

Key Role Responsibilities

* Provide direction and give guidance on coding best practices

* Responsible for identifying the impact of documentation and coding on risk adjustment model

* Evaluate the element of the medical record for diagnosis code selection

* Educate healthcare provider, coder and/or office staff about the risk adjustment model, documentation and coding

* Improve the practice's documentation and coding accuracy and help the practice adopt more efficient and effective processes

* Create a long-term, self-sustaining solution for the healthcare provider's practice

* Assist healthcare providers to document accurately and code to the highest level of specificity in order to capture a member's true health status at the time of care

* Query providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding

* Perform chart review and identify previously accepted/undocumented conditions to accurately report patient's true health status

* Demonstrate analytical and problem-solving ability with regard to barriers in receiving and validating accurate HCC information

* Perform targeted audits of charts based on system generated reports with special screening criteria and be able to communicate findings clearly and concisely, orally and in writing

* Support and participate in process and quality improvement initiatives

* Take responsibility and ownership of coding projects as assigned. Work with other team members and ensure completion with appropriate speed and expected accuracy

* Keep current on all governmental medical and legal issues specific to coding and compliance.

* Responsible for sharing knowledge of issues with Medicare Risk Adjustment Manager

* Attends seminars and in-services as required to remain current on coding issues

* Other duties as assigned.

Role Essentials

* Minimum of 3 years HCC documentation and coding review experience

* CPC certification is required

* Strong interpersonal skills including: effective communication, listening and professionalism, problem-solving and team-building skills, self-management, responsibility and accountability

* Attention to detail

* Strong analytical skills

* Proficient in the use of MS Office

* Knowledge of EMR for reviewing records

* Experience in provider setting
Role Desirables

* Other certifications as follows - CPCI (Certified Professional Coder-Instructor), CPMA (Certified Professional Medical Auditor), HIM (Health Information Management), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist-Physician), RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), Billing certification

**Title:** *Medicare Risk Adjustment HCC Coding and Clinical Documentation Analyst*

**Location:** *Kansas-Wichita*

**Other Locations:** *US-Oklahoma-Oklahoma City*

**Requisition ID:** *193809*

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.

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