Coding Analyst - Risk Adjustment and HCC

ESSENTIAL DUTIES AND RESPONSIBILITIES

Operations:

Review medical records to identify appropriate codes according to HCC, CPT, and ICD-10 models. Verify and ensure the accuracy and completeness of codes. Review and provide feedback on documentation and codes submitted by providers, colleagues, external stakeholders, or from EHR systems.

Monitoring:

Performs coding quality reviews in accordance with Conifer applicable monitoring policies of achieving 95% accuracy or higher.

Conducts chart audits to identify additional codes (ICD-10 or procedure, CPT-4, CPT II, HCPCS, etc). Organizes and reviews charts for coding audits and prepares action plans in response to audit findings.

Maintaining Stakeholder Relationships:

Responds to inquiries from health plans and providers. Oversees data submissions to client, vendors, and internal stakeholders. Conducts trainings and outreach to provider offices.

Professional Development:

Maintains knowledge of changes in coding guidelines. Attends and participates in meetings and is responsible for coding related information communicated at meetings. Attends relevant coding workshops. Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD 10-CM and CPT coding. Attends mandatory coding seminars on annual basis (IPPS and OPPS, ICD-10 and CPT updates) for inpatient and outpatient coding. Quarterly review of AHA Coding Clinic. Attends Quarterly Coding Updates, all coding conference calls and CDI taskforce meetings.

CDI:

Communicates documentation improvement opportunities and coding

issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up, educational topics and resolution

KNOWLEDGE, SKILLS, ABILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Knowledge and understanding of coding processes, coding system software, and electronic medical records
• Knowledge of key regulatory issues associated with HCC coding and reporting
• Familiarity with and comfort using databases used for quality reporting
• Proficiency in Microsoft Office is required (Excel, PowerPoint, Outlook and Word)
• Adept at comparing documentation, code assignment and charge in the financial system for accuracy and completeness
• Knowledge of ICD-10-CM, ICD-10-PCS, and CPT coding principles and rules
• Knowledge of disease pathophysiology, drug utilization, and medical records systems
• Leadership and communication skills, problem solving abilities, customer service skills
• Ability to build and maintain team dynamics
• Autonomy; must be self-directed.
• Implement policies and procedures that guide and support the provision of services
• Coding proficiency demonstrated by successful completion of approved coding exercise
• Complies with all policies and procedures that pertain to HIPAA including minimum necessary requirements for this position. Must maintain 100% patient confidentiality for PHI
• Organizational skills for initiation and maintenance of efficient workflow
• Capacity to work independently in a virtual office setting.
• Abides by the Standards of Ethical Coding set forth by AMA and monitors coding staff for violations and reports as areas of concern are identified.
• Maintains knowledge of current professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions.
• Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function.
• Demonstrates competency in the use of computer applications, and all coding and abstracting software.
• Demonstrates initiative and discipline in time management and assignment completion.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

• Three (3) years in coding
• Prefer five (5) years experience in coding, with knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS and documentation guidelines
• High school diploma; Associate degree preferred

CERTIFICATES, LICENSES, REGISTRATIONS

• Preferred: AAPC, CPC, CRC, or AHIMA RHIT/RHIA credentials

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit for extended periods of time
• Must be able to efficiently use computer keyboard and mouse to perform coding assignments
• Occasional standing/walking, reaching, stooping, bending
• Manual dexterity and mobility

WORK ENVIRONMENT

• Office Work Environment (RTO)
• Night Shift

OTHER

• Must meet the requirements of the Conifer Telecommuting Program Guide and the Remote Coder Policy