Risk Adjustment Coding Analyst Senior

About the role

This position is responsible for diagnosis coding review and vendor coding quality assurance; working to ensure that plan performance and plan revenue is based on an accurate representation of our population's care needs and risks.

Accountabilities

• Performs retrospective chart review for diagnosis coding accuracy
• Identifies, analyzes, and reports coding error trends to inform risk adjustment analytics and deliver provider education
• Reviews vendor coding and provide recurring feedback and education to vendor team
• Participates in internal and CMS-mandated risk adjustment data validation review
• Identifies, documents, and messages process improvements, clinical documentation improvements and/or other educational opportunities
• Develops and performs training and educational seminars to physicians and advanced practice providers on risk adjustment topics
• Increases collaborative efforts between HealthPartners Health Plan and HealthPartners Medical Group as it relates to optimization of diagnosis coding
• Analyzes and organizes complex information for effective reporting to leadership
• Conducts daily work consistent with HealthPartners core values and comply with all federal and state regulations
• Maintains confidentiality of protected health information
• Increases organizational efficiency in daily operations
• Responsible for other duties as assigned

Required Qualifications

• High School Diploma or GED or Associate's degree in a related field
• One of the following credentials required: RHIA, RHIT, CPC, CCS, CCS-P
• Certified Risk Adjustment Coder (CRC) credential
• Minimum of five years experience with diagnosis coding review as a certified coder
• Demonstrated working knowledge of the revenue cycle process, claims processing, retrospective chart review process, compliance and federal/state regulations, CPT, ICD-9, and ICD-10 coding
• Identify issues and formulate solutions relating to retrospective chart review process improvement initiatives
• Understand and communicate clinical documentation requirements for correct coding and to ensure integrity of the medical record
• Skill and experience in effectively collaborating with team members & others using oral, written and interpersonal communications
• PC skills in Microsoft Word and Excel
• Organize and prioritize multiple assignments
• Ability to deal with change and ambiguity
• Able to work, both, as a team member or independently

Preferred Qualifications

• Four year college degree
• Experience working with Epic