Community Hospital of the Monterey Peninsula

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Risk Adj Coding Coord_Qual Care Mgmt

at Community Hospital of the Monterey Peninsula

Posted: 3/19/2019
Job Status: Full Time
Job Reference #: 2787

Job Description

Monterey, CA

Full Time (Exempt)

Work Hours: M - F Generally 8:00 AM - 5:00 PM


Position:                                 Risk Adjustment Coding Coordinator
Location:                                Monterey, CA
Reports to:                             Director of Practice Enhancement Analytics
Schedule:                                Exempt
Company Overview
Aspire Health Plan is a locally owned Medicare Advantage HMO that provides comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. We’re proud to be a community-centered organization backed by Montage Health and Salinas Valley Memorial Health System. Over 700 doctors, many other healthcare providers, and all four Monterey County hospitals are part of the Aspire Health Plan network. It’s the care you need from people you know.
Purpose of Position
The Risk Adjustment Coding Coordinator is responsible for providing training to medical groups related to HCC documentation and for coding auditing medical records to ensure coding completeness and accuracy. The Coordinator works with medical groups to improve reporting of clinical documentation required for closing quality and chronic condition care gaps. The Coordinator ensures ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) are accurate, appropriate and supported by written clinical documentation in accordance with all Federal and State regulations and internal policies and procedures. The incumbent will also assist leadership in the development of education sessions related to audit findings to improve accuracy of chronic condition reporting.
  • Assist providers and their staff in understanding the CMS-HCC Risk Adjustment program, and other risk-based contracts, as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnoses coding.
  • Educate providers and staff on coding regulations and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations.
  • Deliver care gap worksheets to provider offices, review chart audit findings, and develop a process for ongoing retrieval of medical records from provider offices.
  • Perform risk adjustment data validation for accurate ICD-9-CM/ICD-10-CM diagnosis coding for Montage Health health plan products and contracts based on HCC and other models.
  • Assess adequacy of documentation and query providers to obtain additional medical record documentation, or to clarify documentation, to ensure accurate and appropriate coding
  • Documents detailed chart audit findings including all coding and documentation errors as well as any potential HCC opportunities.
  • Provides formal report(s) on audit findings and conduct education to internal and external coders based upon those findings.
  • Assists leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
  • Routinely consults with medical providers to clarify missing or inadequate record information to determine appropriate diagnostic and procedure codes.
  • Maintain current knowledge of ICD-9-CM/ICD-10-CM codes, CMS documentation requirements, and state and federal regulations and provide ICD10 - HCC coding training to providers and appropriate staff (not including CEUs)
  • Provide provider education / coding audits for lines of business within the enterprise as needed
  • Performs other related duties as required or assigned.
Experience/Skill Set
  • 2+ years of hands on coding experience in the Risk Adjustment environment
  • Vast knowledge of ICD-9 and ICD-10
  • Intermediate Excel skills as well as proficient in other MS Office Applications
  • Strong communication skills both written and verbal
  • Ability to travel up to 75% within Monterey County
  • Current core coding credential through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.) required
  • Certified Medicare Risk Adjustment Coder AND/OR Certified Professional Coder required
  • AccountabilityandDependability:Assumesresponsibilityforaccomplishingdutiesinaneffectiveandtimelymanner.
  • Integrity:  Consistently honors commitments and takes responsibility for actions and words.
  • Software and Computer Skills:Proficient in the use of Microsoft Office Suite, Highly skilled at using the Internet .Must learns effectively with computer-based and/or online training.
  • Flexibility:  Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.
  • Inclusiveness:  The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.
Equal Opportunity Employer

Application Instructions

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