Risk Adjustment Analyst - HIM OP CDI

Responsibilities

• Perform payer audits as required under the Value Care contracts by validating providers and researching/presenting requested information.
• Review HCC Edit WQ to reorder top 12 diagnoses for claim generation.
• Avoid HCC Persistency issues by completing pre-visit medical record reviews and identifying conditions from the past two years needing refreshment for the current calendar year.
• Create and update education tip sheets and tools for providers and clinical staff.
• Utilize compliant query processes to facilitate appropriate clinical documentation and support severity of illness, HCCs, and complexity of care.
• Communicate and collaborate with clinical and non-clinical staff to resolve queries/prompts.
• Use software systems like PCIC dashboard and reports, Excel spreadsheets for accurate data collection and reporting KPI metrics/outcomes.

Qualifications

• High school diploma or GED required.
• Successful completion of the OP CDI Proficiency Test.
• One of the following certifications: AHIMA, AAPC (CPC or CRC), ACDIS, RN, LPN, Advance Practice Provider (NP or PA), MD license.
• Minimum of twelve (12) months of OP coding experience or nursing experience in an ambulatory care setting.
• Strong knowledge of medical record documentation requirements and coding guidelines.
• Strong ambulatory care clinical knowledge of clinical indicators, disease processes, and treatment.
• Effective communication skills, both written and verbal.
• Organizational skills, time management, flexibility, and ability to manage multiple priorities.
• Strong critical thinking and sound judgment in decision-making.