Medical Coder
Aya Healthcare
- Boston, Massachusetts, United States
- Boston, Massachusetts, United States
About
Perform pre-visit planning chart review for up-coming patient appointments Identify clinical indicators for suspect high-risk conditions to accurately capture patient disease burden and improve patient outcomes and reduce hospitalizations WellSense contract performance and improve provider clinical documentation Create compliant Risk Adjustment CDI queries based on clinical indicators found in chart review Manage CDI query provider engagement respond to provider questions assess clinical documentation to ensure documentation integrity and compliance with reported disease burden Identify areas of risk and opportunity in provider documentation and coding in order to uphold clinical documentation integrity to ultimately reduce healthcare resource utilization Identify documentation education for Risk Adjustment/HCC documentation and coding Track and Trend CDI findings and provider engagement for clinical documentation education purposes for any specialty within the hospital system Potential to support on additional types of Risk Adjustment reviews Additional duties as assigned
Job Requirements Required Education and Experience:
Bachelors degree in Nursing or Health Information Management is required Minimum 5 years related experience working on the payer or provider side in Risk Adjustment Validation including prospective documentation reviews and pre-visit planning Or Equivalent combination of education and experience
Preferred Education and Experience:
Population Health experience NCQA/HEDIS CDS experience
Certifications Licenses Registrations Required:
Certified Risk Adjustment Coder
Certifications Licenses Registrations Preferred:
CCDS CCDS-O CPMA CDEO RHIT/RHIA
Knowledge Skills & Abilities (KSAs):
Knowledge of care delivery documentation systems and related medical record documents. Knowledge of age-specific needs and the elements of disease processes and related procedures. Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes. Excellent written and verbal communication skills. Excellent critical thinking skills. Excellent understanding of Compliant Query processes in Risk Adjustment/Outpatient CDI. Excellent understanding of ICD10CM coding and guidelines Excellent understanding of risk adjustment methodology and value based care. Working knowledge of CPT/HCPCS level II Coding Ability to develop and maintain employee and medical staff relationships. Ability to work independently in a time-oriented environment. Computer literacy and familiarity with Microsoft 365 and basic office equipment. Competency in tracking outcomes of risk adjustment/CDS activities. Ability to adapt to changes in the workload to work independently and effectively prioritize work assignments Knowledge of DxCG Risk Adjustment methodology (MassHealth Medicaid)
Languages
- English
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