Partners Health Management
HEDIS Coding Specialist (Remote Option-NC)
Partners Health Management, Elkin, North Carolina, United States, 28621
Overview
HEDIS Coding Specialist (Remote Option-NC) Primary Purpose Of Position: The HEDIS Coding Specialist plays a critical role in ensuring accurate and compliant coding, documentation improvement, and adherence to National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. The specialist reviews medical records, identifies appropriate diagnosis codes, and ensures documentation supports coding accuracy. They collaborate with healthcare providers to address incomplete or missing clinical documentation, educate on proper coding practices, and facilitate training sessions as needed. By conducting audits, analyzing data, and communicating with internal and external stakeholders, the specialist helps improve coding accuracy, optimize revenue, and enhance the quality of care delivered to patients. The role requires meticulous attention to detail, strong analytical skills, and compliance expertise to meet HEDIS reporting requirements and quality improvement goals.
Responsibilities
Coding Review: Conduct reviews of medical records to ensure accurate coding and documentation in compliance with NCQA HEDIS measures and risk adjustment requirements.
Documentation Improvement: Identify opportunities for documentation improvement to support accurate coding and alignment with coding guidelines and regulatory standards.
Provider Education: Collaborate with healthcare providers to educate on proper documentation practices, coding guidelines, and HEDIS measures. Provide guidance to facilitate accurate coding and documentation.
Auditing: Perform audits to assess coding accuracy and completeness; identify discrepancies and areas for improvement.
Risk Adjustment Coding: Apply expertise in risk adjustment coding to accurately capture and report diagnosis codes relevant to HCCs and related reimbursement initiatives.
Data Analysis: Analyze coding and documentation data to identify trends and opportunities for improvement; use data-driven insights to develop strategies for enhancing accuracy.
Quality Assurance: Ensure compliance with coding and documentation guidelines, regulatory requirements, and organizational standards; monitor practices to maintain quality and integrity.
Provider Support: Serve as a resource for providers, offering guidance and assistance with coding-related inquiries and documentation queries.
Training and Development: Develop and deliver training sessions, workshops, or educational materials on coding best practices, documentation requirements, and HEDIS measures.
Collaboration: Work with Quality Improvement, Provider Relations, Data Analytics, and other teams to support quality initiatives and address coding issues.
Reporting: Generate reports to track coding accuracy and compliance with HEDIS measures; communicate findings to stakeholders as needed.
Continuous Learning: Stay updated on coding guidelines, documentation standards, and regulatory requirements.
Knowledge, Skills and Abilities
Medical Coding: ICD-10-CM, CPT, and HCPCS coding systems; coding conventions and updates.
HEDIS Measures: Familiarity with NCQA HEDIS measures, specifications, and reporting.
Risk Adjustment: Understanding of risk adjustment methodologies and HCCs.
Clinical Documentation: Knowledge of clinical documentation standards and terminology.
Regulatory Compliance: Understanding of healthcare regulations related to HEDIS, risk adjustment, and medical coding.
Additional Skills
Coding Proficiency: Accurately assign diagnosis and procedure codes based on documentation.
Attention to Detail: Identify discrepancies and deficiencies; ensure accuracy.
Analytical Skills: Analyze data to support quality improvement.
Communication: Convey guidelines effectively and collaborate with teams.
Problem-Solving: Address coding challenges and implement improvements.
Abilities
Adaptability: Adjust to changes in guidelines and requirements.
Time Management: Prioritize tasks and manage multiple projects.
Collaboration: Work with providers and cross-functional teams.
Continuous Learning: Commit to ongoing professional development.
Quality Focus: Maintain high standards for coding and documentation.
Education and Experience
Bachelor’s degree in Health Information Management (HIM), Health Information Technology, Medical Coding, Nursing, or related field; OR
Associate’s degree in HIM or Medical Coding with minimum 3 years of medical coding experience
Experience: Minimum 2-3 years in medical coding and documentation; minimum 1 year with HEDIS measures and reporting; experience with risk adjustment and HCC coding preferred
Technical Skills
Proficiency in ICD-10-CM/PCS, CPT, and HCPCS; experience with coding software and audit tools
Advanced Excel skills for data analysis and reporting
Performance Metrics
Coding accuracy rate of 95% or higher
Ability to code 20-25 charts per day while maintaining quality
Education/Experience Preferred
Master’s degree in health information management or related field
5+ years of medical coding experience
Experience in managed care or health plan environment
Experience with Epic, Cerner, or other major EHR systems
Knowledge of Medicare Advantage and Medicaid managed care operations
SQL or other database query languages knowledge preferred
Licensure/Certifications Required
Current AHIMA certification (CCS, RHIA, RHIT) or AAPC (CPC, CRC)
HEDIS certification or ability to obtain within 6 months of hire
Additional Details
Office Location: Remote option; available for NC locations or within 40 miles of NC border
Closing Date: Open Until Filled
Note: Referrals increase your chances of interviewing.
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HEDIS Coding Specialist (Remote Option-NC) Primary Purpose Of Position: The HEDIS Coding Specialist plays a critical role in ensuring accurate and compliant coding, documentation improvement, and adherence to National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. The specialist reviews medical records, identifies appropriate diagnosis codes, and ensures documentation supports coding accuracy. They collaborate with healthcare providers to address incomplete or missing clinical documentation, educate on proper coding practices, and facilitate training sessions as needed. By conducting audits, analyzing data, and communicating with internal and external stakeholders, the specialist helps improve coding accuracy, optimize revenue, and enhance the quality of care delivered to patients. The role requires meticulous attention to detail, strong analytical skills, and compliance expertise to meet HEDIS reporting requirements and quality improvement goals.
Responsibilities
Coding Review: Conduct reviews of medical records to ensure accurate coding and documentation in compliance with NCQA HEDIS measures and risk adjustment requirements.
Documentation Improvement: Identify opportunities for documentation improvement to support accurate coding and alignment with coding guidelines and regulatory standards.
Provider Education: Collaborate with healthcare providers to educate on proper documentation practices, coding guidelines, and HEDIS measures. Provide guidance to facilitate accurate coding and documentation.
Auditing: Perform audits to assess coding accuracy and completeness; identify discrepancies and areas for improvement.
Risk Adjustment Coding: Apply expertise in risk adjustment coding to accurately capture and report diagnosis codes relevant to HCCs and related reimbursement initiatives.
Data Analysis: Analyze coding and documentation data to identify trends and opportunities for improvement; use data-driven insights to develop strategies for enhancing accuracy.
Quality Assurance: Ensure compliance with coding and documentation guidelines, regulatory requirements, and organizational standards; monitor practices to maintain quality and integrity.
Provider Support: Serve as a resource for providers, offering guidance and assistance with coding-related inquiries and documentation queries.
Training and Development: Develop and deliver training sessions, workshops, or educational materials on coding best practices, documentation requirements, and HEDIS measures.
Collaboration: Work with Quality Improvement, Provider Relations, Data Analytics, and other teams to support quality initiatives and address coding issues.
Reporting: Generate reports to track coding accuracy and compliance with HEDIS measures; communicate findings to stakeholders as needed.
Continuous Learning: Stay updated on coding guidelines, documentation standards, and regulatory requirements.
Knowledge, Skills and Abilities
Medical Coding: ICD-10-CM, CPT, and HCPCS coding systems; coding conventions and updates.
HEDIS Measures: Familiarity with NCQA HEDIS measures, specifications, and reporting.
Risk Adjustment: Understanding of risk adjustment methodologies and HCCs.
Clinical Documentation: Knowledge of clinical documentation standards and terminology.
Regulatory Compliance: Understanding of healthcare regulations related to HEDIS, risk adjustment, and medical coding.
Additional Skills
Coding Proficiency: Accurately assign diagnosis and procedure codes based on documentation.
Attention to Detail: Identify discrepancies and deficiencies; ensure accuracy.
Analytical Skills: Analyze data to support quality improvement.
Communication: Convey guidelines effectively and collaborate with teams.
Problem-Solving: Address coding challenges and implement improvements.
Abilities
Adaptability: Adjust to changes in guidelines and requirements.
Time Management: Prioritize tasks and manage multiple projects.
Collaboration: Work with providers and cross-functional teams.
Continuous Learning: Commit to ongoing professional development.
Quality Focus: Maintain high standards for coding and documentation.
Education and Experience
Bachelor’s degree in Health Information Management (HIM), Health Information Technology, Medical Coding, Nursing, or related field; OR
Associate’s degree in HIM or Medical Coding with minimum 3 years of medical coding experience
Experience: Minimum 2-3 years in medical coding and documentation; minimum 1 year with HEDIS measures and reporting; experience with risk adjustment and HCC coding preferred
Technical Skills
Proficiency in ICD-10-CM/PCS, CPT, and HCPCS; experience with coding software and audit tools
Advanced Excel skills for data analysis and reporting
Performance Metrics
Coding accuracy rate of 95% or higher
Ability to code 20-25 charts per day while maintaining quality
Education/Experience Preferred
Master’s degree in health information management or related field
5+ years of medical coding experience
Experience in managed care or health plan environment
Experience with Epic, Cerner, or other major EHR systems
Knowledge of Medicare Advantage and Medicaid managed care operations
SQL or other database query languages knowledge preferred
Licensure/Certifications Required
Current AHIMA certification (CCS, RHIA, RHIT) or AAPC (CPC, CRC)
HEDIS certification or ability to obtain within 6 months of hire
Additional Details
Office Location: Remote option; available for NC locations or within 40 miles of NC border
Closing Date: Open Until Filled
Note: Referrals increase your chances of interviewing.
#J-18808-Ljbffr