Summary
The Risk Coding Analyst will conduct provider medical record audits analyzing medical record documentation to ensure accuracy of CMS Hierarchical Condition Categories (HCC) and determines potential chronic conditions applicable to MRA reimbursement.
- Subject matter experts for proper risk adjustment coding and CMS data validation
- Reviews documentation for missed conditions
- Works in conjunction with internal positions to include Provider Relations, Quality, and Clinical Coding Nurse Consultants to ensure compliance of CMS risk adjustments guidelines are met.
- Analyze MRA data to identify patterns and development of interventions to coordinate an educational work plan
- Communicates audit results to the Clinical Coding Nurse Consultants with suggestions for improvement and re-training topics
- Participates effectively in Clinical Documentation Improvement (CDI) initiatives and team meetings to promote quality across all project
Requirements
Educational Requirements
Degree / Diploma Obtained Program of Study Required /
Preferred and / or BachelorsPreferred
Experience Requirements
Minimum Years Required Area of Experience Required /
Preferred and / or
Certifications / Registration Requirements
Certificates / Registrations Required /
Preferred and / or Certified Professional Coder (CPC)Required
Other Requirements
Must possess excellent written and verbal communication skills and the ability to deliver technical instruction to medical staff.
Extensive knowledge of CPT and ICD-10 guidelines and principles. Must have a firm understanding of medical terminology. Must possess an independent working knowledge of Microsoft office products inclusive of word, excel and PowerPoint.
Risk Coding Analyst
The Risk Coding Analyst will conduct provider medical record audits analyzing medical record documentation to ensure accuracy of CMS Hierarchical Condition Categories (HCC) and determines potential chronic conditions applicable to MRA reimbursement. Subject matter experts for proper risk adjustment ...
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