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Risk Adjustment Supervisor - Full Time Days - Immanuel Home Office

Immanuel locationOmaha, NE
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91 positions
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Web Mktg Technology Specialist

Immanuel locationOmaha, NE
91 positions
info linkReport a probelm Originally Posted : April 06, 2021 | Expires : May 6, 2021

Details

Salary
Unspecified
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Job Location
Omaha, NE, United States

Description

The overall purpose of this job is to oversee the Risk Adjustment functions for Immanuel Pathways. Responsibilities of the role include conducting internal and external provider medical record audits, oversight of concurrent coding and analysis of practice coding patterns and the development of policies and procedures. This position will also provide education and training, development of clinical documentation to ensure accurate and timely medical record review and validation of Hierarchical Conditional Categories (HCC’s), while adhering to coding standards and Centers for Medicare and Medicaid Risk Adjustment Coding Guidelines. Supports and lives out Immanuel’s Mission and CHRIST Promises.

Key Areas

Key Responsibilities and Duties of the Job

Consulting and Advising

 

  • Provides consultation to all specialties (i.e., PT/OT/PCP/SW) for detection of secondary complications and co-morbid conditions.
  • Provides training and educational materials for all specialties that document for Risk Adjustment.
  • Utilizes knowledge of coding principles to educate all specialties on documentation and coding to ensure the highest level of specificity and compliance with CMS regulations.
  • Provides real-time consultation with providers regarding documentation and coding questions.

Auditing/Monitoring

  • Performs audits and interpretation of medical documentation to capture all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
  • Performs quality reviews and general oversight of coding vendor to ensure all collected data is accurate, complete, and compliant with state and federal regulations as well as the Official Guidelines of Coding and Reporting.
  • Augments consultant auditing to ensure all charts are audited once per year to identify incomplete or missing records and documentation, and ambiguous or nonspecific documentation.
  • Performs reviews for prospective and retrospective audits, yearly.
  • Performs initial assessment review to determine appropriate medical coding from past medical records.

Risk Adjustment

 

  • Oversees the Risk Adjustment model initiatives to facilitate achievement of the business goals and objectives.
  • Maintains policies and procedures relating to the Risk Adjustment model.
  • Oversees the education of internal departments on the critical nature of Risk Adjustment.
  • Provides development and management oversight of the Risk Adjustment processes and identifies risks, opportunities, and improvements associated with current processes.

Compliance/Reporting

 

  • Compiles detailed findings and prepares reports upon completion of coding, medical claims, and documentation audits.
  • Analyzes coding data and errors/irregularities to determine trends and root causes for variations. Provides audit results and shares recommendations for course-correction and education, as needed.
  • Reviews coding reports to ensure ongoing diagnoses are appropriately documented and follows up with all specialties regarding dropped Hierarchical Condition Categories (HCC) and documentation requirements.
  • Analyzes reports to monitor both favorable and unfavorable trends over time and brings the data analysis and recommendations to manager’s attention for discussion and remediation.
  • Analyzes diagnosis codes to detect and prevent Fraud, Waste, and Abuse as it relates to the prescribing of medications.

Staff Management

 

  • Provides leadership for staff members to include hiring and training new staff members, setting goals and objectives to produce desired outcomes in the Immanuel organization and evaluation performance, overseeing the functions of staff members to utilize talents and resources effectively.
  • Leverages strengths of team members, helps to clarify roles and responsibilities, develops and implements training programs in order to maximize and reach optimal individual and organizational goals.
  • Embraces educational opportunities and/or professional coaching to enhance/improve managerial skills.

Other

 

  • Participates in workgroups/committee meetings and process improvement solutions, as required.
  • Maintains all coding sets within the electronic health record system.
  • Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise.
  • Stays current in changing Medicare/Medicaid regulatory environment and requirements.
  • Performs other duties as assigned or requested.

Education-                                                                                                                                         

  • Associates degree in related field required.
  • Bachelor’s degree in Healthcare preferred.

Experience-

  • Five (5) years of coding experience (except RHIT).
  • Three (3) years of experience with Risk Adjustment Coding (HCC) preferred.
  • Two (2) years of supervisory experience required.
  • Experience in training and educational sessions with health care providers for medical documentation and coding.
  • Experience with audit and quality assurance with extensive knowledge and understanding of ICD-10-CM/ICD-10-PCS, CPT-4, HCPCS Level II, coding systems, medical terminology, abbreviations, anatomy, physiology and disease.

Other Requirements –

  • Professional Medical Coder Certificate required:
    • Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) Certified.

Education-                                                                                                                                         

  • Associates degree in related field required.
  • Bachelor’s degree in Healthcare preferred.

Experience-

  • Five (5) years of coding experience (except RHIT).
  • Three (3) years of experience with Risk Adjustment Coding (HCC) preferred.
  • Two (2) years of supervisory experience required.
  • Experience in training and educational sessions with health care providers for medical documentation and coding.
  • Experience with audit and quality assurance with extensive knowledge and understanding of ICD-10-CM/ICD-10-PCS, CPT-4, HCPCS Level II, coding systems, medical terminology, abbreviations, anatomy, physiology and disease.

Other Requirements –

  • Professional Medical Coder Certificate required:
    • Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association or Certified Professional Coder (CPC) or Registered Health Information Technologist (RHIT) Certified.

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