Risk Adjustment Coder Analyst- Quality- Hansen

Prevea Health • Ashwaubenon, WI

7d

About The Position

Come work where we specialize in you! We have nearly 2,000 reasons for you to
consider a career with Prevea Health—they're our employees. We're an
organization that values kindness, responsibility, inclusivity, wellness and
inspiration. At Prevea, we provide continuous education, training and support so
every member of the team contributes to our success. Together we are the best
place to get care and the best place to give care.

Job Summary
At 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.

Requirements

• Associate's Degree in healthcare business services, healthcare administration, medical coding or related degree. Required
• 1-3 years 2 years’ experience in a healthcare setting. Required
• The 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 preferred
• Familiarity with medical insurance claims process required.
• Basic understanding of ICD-10 codes
• Certified Professional Coder (CPC) certification Upon Hire Required

Nice To Haves

• 2 years Experience in Hierarchical Condition Categories (HCC) Conditions Preferred
• Certified Risk Adjustment Coder (CRC) certification Upon Hire Preferred

Responsibilities

• Complete 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees