Job Information
Visiting Nurse Service of New York Risk Adjustment Coding Specialist in NEW YORK, New York
Overview Identifies, collects, assesses, monitors and documents ICD-10 diagnoses based coding information as it pertains to CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers on coding compliance and consistency. Supports the creation, maintenance, and enhancement of clinical documentation accuracy in support of building a model of care focused on quality and health outcomes. Works internally to leverage clinical, coding, and documentation expertise to foster improvements in the overall quality, completeness, and compliance of clinical documentation. Assists healthcare providers to understand specific documentation topics as well as the issues facing healthcare providers to create buy-in. Alerts leadership of trends and irregularities evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC alerts addressed at DOS. Works under moderate supervision. What We Provide:Referral bonus opportunitiesGenerous paid time off (PTO), starting at 30 days of paid time off and 9 company holidaysHealth insurance plan for you and your loved ones, Medical, Dental, Vision, Life DisabilityEmployer-matched retirement saving fundsPersonal and financial wellness programsPre-tax flexible spending accounts (FSAs) for healthcare and dependent careGenerous tuition reimbursement for qualifying degreesOpportunities for professional growth and career advancementInternal mobility, generous tuition reimbursement, CEU credits, and advancement opportunitiesWhat You Will Do: Conducts coding reviews independently on all medical record documentation to assign and/or audit the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology. Outreaches supervisor for non-routine issues and new situations.Responsible for ensuring completion of medical record reviews and related accurate score based on monthly target set forth by department. * Keeps current on new coding and billing guidelines and federal and state initiatives regarding claims and educates other departments on new/changes to regulations.Regulatory Oversight and Quality Assurance and performs medical record compliance audits using the most up-to-date CMS guidelines, output generated is submitted to CMS to accurately capture member's acuity resulting in a compliance and financial impact to the organization, maintains high level of quality and production standards required by leadership to ensure continued medical coding accuracy. This requires advanced knowledge, certifications, and experience related to coding/auditing of ICD 10 Diagnoses based on HCC category.Provides audit trail for all identified HCCs in a Medical Record Review through use of audit tool.Identifies all unsupported diagnoses/HCCs for all Risk Adjustment Data Validation (RADV) related projects and appropriately notifies management of deficiencies to report to Encounter submissions team.Provider Engagement, Audit, Training and Support and supports supervisor in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.Reports incidental findings, patterns, and trends from audits/coding projects to supervisor thus assisting supervisor in analyzing audit results, tracking and trending. Responsible for supporting supervisor/manager for testing of Coding/Audit tool to ensure appropriate functioning, identifying trends, making recommendations for process improvement for ensuring compliance.Enterprise Wide Risk Adjustment Collaboration Act