Risk Adjustment Clinical Reviewer Specialist

Corporate St. Louis Park, Minnesota


Description

Position at Lifespark

Position Summary

An HCC coder is an individual who reviews medical charts to perform coding work and ensures that compliance with established protocols and procedures are maintained, by medical facilities where he or she is commissioned. To work as a Risk Adjustment Clinical Reviewer, you must be certified through AHIMA or AAPC, and possess at minimum 2 to 3 years of experience in medical coding, preferred risk adjustment/HCC work experience.

 

The risk adjustment reviewer will identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Medicare HCC and other risk adjustment model diagnosis codes. This individual will verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. Reviewing medical record information to identify all appropriate coding based on CMS HCC and other federal/state diagnostic categories will encompass much of the role. Working as an HCC coder means that you will be providing education and training for other healthcare provider professionals.

 

Serves as coding subject matter expert and assists and/or liaison for internal and external partners

 

Position Core Accountabilities

  • Review medical records and decipher if they are accurate and complete based on services rendered – ongoing to ascertain efficiency and accuracy for providers regarding coding and documentation.
    • Performing chart audits and identifies unreported/missed diagnosis codes, reviewing the documentation for appropriateness of diagnosis codes used,
    • Review of medication lists to verify correlation of conditions or active conditions under treatment
    • Communicates the findings to providers to assist resolution and understanding
  • Educate providers and their staff in Medicare diagnosis coding guidelines
    • Coding and guideline education to all coders and healthcare providers
    • Confers regularly with healthcare provider professionals, managers, coders, or other staff through team meetings, one-on-one meetings, and daily interactive communication to respond to and educate providers on Risk Adjustment/HCC coding issues and updates.
    • Participates in new healthcare provider professional’s orientation as well as provide follow-up reviews and education for the provider for the area of ICD-10/HCC Coding
    • Participates with Risk Adjustment training with outside provider groups
  • Develop tools, materials and plans that support the educational and training needs of the medical practice, by collaborating with internal departments
    • Prepares tracking tools and metrics to ensure that the accuracy and completeness of coding and documentation is improved
  • Prepares tracking tools and metrics to ensure that the accuracy and completeness of coding and documentation is improved
  • Periodic review of codes at least annually or as introduced or required for new, revised, or deleted code updates. Periodic review of CMS Risk Adjustment guidelines
  • Reports regularly on activity, productivity, and findings of reviews and education via electronic file or database, e-mail, paper, or other means as required by coordinator.

Qualifications

Education:

  • Certification through AHIMA or AAPC
  • In Patient Coding: Certified Coding Specialist (CCS) credentials, Outpatient Coding: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician, required.
  • Preference for certification as HCC risk code

Experience:

  • 2+ years of experience in healthcare setting.
  • 3+ years of experience in coding and medical record chart review
  • HCC coding experience
  • CPT/ICD-10 coding experience, additional.

Knowledge / Skills:

  • Experience with HCC (Hierarchical Condition Category) Risk Adjustment Model
  • Background in supporting risk adjustment management activities and clinical informatics.

Key Competencies:

  • HCC Medical record review processes
  • Understanding of regulatory audits and processes
  • Process improvement understanding
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