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The Clinical Analyst reports to the Risk Adjustment Programs Manager in Government Markets. The key responsibilities of this role include analyzing member clinical charts, diagnosis data, CPT Codes, and any other diagnostic data for Independence's Medicare Advantage and Commercial HIX plans to assess chart coding accuracy and determine opportunities for improvement. The Clinical Analyst will perform and participate in prospective chart coding reviews and recommend solutions to improve the quality and accuracy of clinical data for the Government Markets Unit. Additionally, the Clinical Analyst will identify and communicate trends in provider coding and documentation, work closely with the Sr. Clinical Analyst to guide staff in the Population Health department with clinical Medicare/ACA Risk Adjustment and RADV procedures, policies, questions, and issues, resolve clinical risk adjustment problems, and provide the department with clinical guidance with respect to risk adjustment data validation policies, procedures, and processes. The Clinical Analyst will also participate in various corporate-wide projects that will drive the collection of clinical data and will be involved in training providers on risk adjustment coding policies both virtually and on-location at provider offices. Furthermore, the role includes recommending solutions that physicians and their staff can use to improve the quality and accuracy of clinical documentation, maintaining knowledge and understanding of HCC/risk adjustment, coding, and documentation requirements, identifying educational needs, and disseminating clinical coding and documentation best practices to provider offices. Advanced analytical, problem-solving, and strong written communication skills are highly recommended, along with the ability to persuade, negotiate, and resolve issues. The Clinical Analyst must be able to define complex clinical issues and determine solutions, as well as advise management on clinical issues. Other duties may be assigned.
