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HCLA HCC Coding Specialist- Hybrid - Los Angeles, United States - MedPOINT Management
Description
Job Description
Job DescriptionTitle: HCLA HCC Coding Specialist
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MedPOINT, a large MSO in the San Fernando Valley has immediate openings for the following position. Competitive salary and benefits in a collaborative working environment.
Summary:
Responsible for overseeing the quality of both outpatient and inpatient coded clinical and administrative date. Responsible for synthesizing audit findings to provide actionable feedback to physicians and administrators on areas of improvement. Candidate is expected to be an active participant in continuous quality improvement processes and workgroups with a strong partnership with HCC co-worker specialists and other quality management staff. Educate providers and administrative staff on correct coding and charting as it applies to Medicare Advantage and Covered CA members. Will provide in-services in small and large group settings. May requires driving to Southern CA clinics and provider offices.
Duties and Responsibilities:
1. Reviews and audits medical records at provider offices/clinics to identify coding risk areas and ensure that training activities are addressing these areas.
2. Review records for completeness, accuracy and compliance with regulations.
3. Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding.
4. Using independent judgement and sensitivity, review with individual physicians and clinic administrators their audit findings and make suggestions for coding improvements.
5. Provide written documentation of potential HCC codes to providers at the point of care while ensuring accuracy of coding and documentation.
6. Resolve or clarify codes or diagnoses with conflicting, missing or unclear information by consulting with providers.
7. Provide expertise in reviewing and assigning accurate medical diagnoses codes for a wide variety of clinical cases based on services performed by physician and other qualified healthcare providers in the office or clinic setting.
8. Demonstrate sound knowledge of medical coding guidelines and regulations to assist providers and clinic administrators the impact of diagnosis coding on risk adjustment payment models.
9. Maintain a professional and supportive working relationship with clinic staff, health plan staff, administration and physicians.
10. Demonstrate high level of proficiency with documentation review including review of orders/results for lab, imaging, hospital records, EHR, etc. as a possible source for HCC codes.
11. Participate in meetings as requested in order to establish and maintain interdepartmental and external partner communication and cooperation.
12. Work with offices to coordinate completion of Annual Wellness Visits (AWV) for Medicare and Covered CA members.
13. Identifies training needs; prepares training materials and conducts coaching and training as appropriate for clinic staff, physicians and other staff to improve the quality of the diagnosis documentation and accuracy of the collection and coding of members' health data.
14. Performs miscellaneous job-related duties as assigned and requested.
Minimum Job Requirements:
Bachelor's Degree or equivalent experience in finance/business, medical records technology, health services administration, nursing or other ancillary medical area.
