Job Description Details:
Assists ACO/CIN and physician practice leadership with identifying documentation for incomplete or inconsistent documentation in the record which impacts HCC or other risk score coding.
Provides training to health care professionals in ICD-10-CM, CPT, and HCPCS Coding Guidelines, modifier guidelines, documentation guidelines, medical terminology and disease processes.
Conducts pre and post proper coding and documentation review for accuracy.
Reviews charges assigned by providers for accuracy and completeness prior to charge being submitted.
Provides spreadsheets of missing documentation and identifies opportunities for improvement to the ACO/CIN Executive Director and Primary Care leadership.
Assists ACO/CIN and physician practice leadership with quality reviews to validate coding and to ensure compliance with CMS Coding Guidelines and Trinity Standards for Outpatient Physician Services.
Provides training to ACO/CIN physicians and practice leadership on NCQA, Commercial, Medicare Advantage and Medicare Shared Savings Program Quality Metrics.
Participates in Trinity work groups, training, and other efforts and forums to address appropriate coding and documentation for ACO/CIN beneficiaries
Works closely with Hospital Compliance Department
Certified Coder with Hierarchical Condition Category (HCC) experience
Minimum of 5 years experience with Health Care Plan, Healthcare System, Management Services Organization (MSO) or Managed Care Organizations (MCO)
RHIA, RHIT, CPC or CCS/CCS-P with completion of an associates or bachelors degree