Direct Jobs
Risk Adjustment Analyst - HIM OP CDI
Direct Jobs, Chapel Hill, North Carolina, United States, 27517
Overview
Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary:
The Risk Adjustment Coordinator will be responsible for analyzing and auditing medical records retrospectively as requested by insurance companies as required by the third party payer under the value care contracts. In addition, the Risk Adjustment Coordinator will be responsible for working the EPIC WQ to reorder the Hierarchical Condition Categories (HCC) conditions in the top 12 for claim generation. The Risk Adjustment Coordinator will complete Pre-Visit Planning reviews daily to improve HCC capture and HCC Persistency. Responsibilities
Perform the payer audits as required under the Value Care contracts by performing validation of the providers and researching and responding to information requested by the payer. Review the cases in the HCC Edit WQ to determine the HCCs that need to be reordered in the top 12 diagnoses before releasing on the claim for billing. Assist with creation and updating education tip sheets and tools for providers and other clinical and OP CDI staff such as the HCC/RAF Pocket Guide, HCC Coding Tip Sheets by clinical conditions, and relevant information in the Clinical Documentation Handbook. Perform pre-visit medical record reviews for patients' upcoming clinic visits to identify conditions captured over the past 2 years that require refreshing for the current calendar year. HCC conditions that impact HCC Persistency must be documented at least annually. Create queries/prompts to the provider according to the defined process to facilitate appropriate clinical documentation supporting severity of illness, hierarchical condition categories, and complexity of care rendered to all patients. Utilize the compliant query process according to guidelines, policy, and the AHIMA Standards of Practice. Communicate and collaborate with clinical and non-clinical staff to expedite the resolution of queries/prompts. Utilize software systems such as the PCIC dashboard and reports, and Excel spreadsheets to ensure accurate data collection both pre-visit and post-visit for reporting KPI metrics and outcomes. Demonstrate responsibility for professional growth and development by actively learning and participating in continuing education offerings. Maintain competence in documentation requirements, coding guidelines, and quality measures. Other Information
Education Requirements: High school diploma or GED required. Successful completion of the OP CDI Proficiency Test. Licensure/Certification Requirements: AHIMA (American Health Information Management Association) certification AAPC (American Academy of Professional Coders) certification CPC (Certified Professional Coder) or CRC (Certified Risk Coder) ACDIS (Association of Clinical Documentation Improvement Specialists) certification RN (Registered Nurse) license LPN (Licensed Practical Nurse) license Advanced Practice Provider (NP or PA) license Medical Doctor (MD) license Professional Experience Requirements: Minimum of twelve (12) months of OP coding experience or nursing experience in an ambulatory care setting Knowledge/Skills/Abilities Requirements: Strong knowledge of medical record documentation requirements and coding guidelines in accordance with third party payer, state and federal regulations. Strong ambulatory care clinical knowledge of clinical indicators, disease processes, and treatment. Must possess strong communication skills, both written and verbal. Exhibit effective organizational skills, time management, ability to be flexible, and management of multiple priorities. Strong critical thinking and sound judgment in decision-making. Job Details
Legal Employer: NCHEALTH Entity: Shared Services Organization Unit: HIM OP CDI Work Type: Full Time Standard Hours Per Week: 40.00 Salary Range: $24.73 - $35.56 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Remote Work Schedule: Day Job Location of Job: US:NC:Chapel Hill Exempt From Overtime: Exempt: No This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job. Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.
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Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary:
The Risk Adjustment Coordinator will be responsible for analyzing and auditing medical records retrospectively as requested by insurance companies as required by the third party payer under the value care contracts. In addition, the Risk Adjustment Coordinator will be responsible for working the EPIC WQ to reorder the Hierarchical Condition Categories (HCC) conditions in the top 12 for claim generation. The Risk Adjustment Coordinator will complete Pre-Visit Planning reviews daily to improve HCC capture and HCC Persistency. Responsibilities
Perform the payer audits as required under the Value Care contracts by performing validation of the providers and researching and responding to information requested by the payer. Review the cases in the HCC Edit WQ to determine the HCCs that need to be reordered in the top 12 diagnoses before releasing on the claim for billing. Assist with creation and updating education tip sheets and tools for providers and other clinical and OP CDI staff such as the HCC/RAF Pocket Guide, HCC Coding Tip Sheets by clinical conditions, and relevant information in the Clinical Documentation Handbook. Perform pre-visit medical record reviews for patients' upcoming clinic visits to identify conditions captured over the past 2 years that require refreshing for the current calendar year. HCC conditions that impact HCC Persistency must be documented at least annually. Create queries/prompts to the provider according to the defined process to facilitate appropriate clinical documentation supporting severity of illness, hierarchical condition categories, and complexity of care rendered to all patients. Utilize the compliant query process according to guidelines, policy, and the AHIMA Standards of Practice. Communicate and collaborate with clinical and non-clinical staff to expedite the resolution of queries/prompts. Utilize software systems such as the PCIC dashboard and reports, and Excel spreadsheets to ensure accurate data collection both pre-visit and post-visit for reporting KPI metrics and outcomes. Demonstrate responsibility for professional growth and development by actively learning and participating in continuing education offerings. Maintain competence in documentation requirements, coding guidelines, and quality measures. Other Information
Education Requirements: High school diploma or GED required. Successful completion of the OP CDI Proficiency Test. Licensure/Certification Requirements: AHIMA (American Health Information Management Association) certification AAPC (American Academy of Professional Coders) certification CPC (Certified Professional Coder) or CRC (Certified Risk Coder) ACDIS (Association of Clinical Documentation Improvement Specialists) certification RN (Registered Nurse) license LPN (Licensed Practical Nurse) license Advanced Practice Provider (NP or PA) license Medical Doctor (MD) license Professional Experience Requirements: Minimum of twelve (12) months of OP coding experience or nursing experience in an ambulatory care setting Knowledge/Skills/Abilities Requirements: Strong knowledge of medical record documentation requirements and coding guidelines in accordance with third party payer, state and federal regulations. Strong ambulatory care clinical knowledge of clinical indicators, disease processes, and treatment. Must possess strong communication skills, both written and verbal. Exhibit effective organizational skills, time management, ability to be flexible, and management of multiple priorities. Strong critical thinking and sound judgment in decision-making. Job Details
Legal Employer: NCHEALTH Entity: Shared Services Organization Unit: HIM OP CDI Work Type: Full Time Standard Hours Per Week: 40.00 Salary Range: $24.73 - $35.56 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Remote Work Schedule: Day Job Location of Job: US:NC:Chapel Hill Exempt From Overtime: Exempt: No This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job. Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.
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