HCC Risk Adjustment Specialist
Methodist Health System Omaha, NE
Purpose of Job
Not necessary for the position (0%):
Occasionally Performed (1%-33%):
Frequently Performed (34%-66%):
Constantly Performed (67%-100%):
Chemical agents (Toxic, Corrosive, Flammable, Latex)
Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
Explosives (pressurized gas)
Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
Mechanical moving parts/vibrations
Essential Job Functions
Essential Functions I
Ability to review documentation and abstract all codes with specific emphasis on identifying the most accurate severity of illness according to CMS HCC (Hierarchical Conditions Categories) guidelines.
Effectively uses computer to review and interpret medical records and applies in-depth knowledge of coding principles to validate missing, incomplete or incorrect International Classification of Disease-10 (ICD-10) diagnosis codes.
Assist in the development of appropriate forms for data collection and analysis.
Strong understanding of the HCC concepts and impact on Population Health Risk Adjustment reimbursement initiatives.
Acts as primary resource in HCC guidelines and coding practices.
Utilizes multiple reports related to risk adjustment to determine focus audit or educational outreach and initiatives directly affecting reimbursement.
Identify and confirm unreported and/or unresolved medical conditions of members based on supportive medical documentation.
Applies ICD-10 Diagnosis Codes to Cerner Problem List.
Removes duplicate, non-specific or resolved ICD-10 Diagnosis codes from Cerner Problem List.
Demonstrates advanced knowledge of medical terminology, anatomy and physiology.
Identifies and reports issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding guidelines.
Inquires with Physicians when ICD-10 code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes; follows up with Physician until resolved.
Responds to queries from coders & providers to update and maintain the problem list with additional diagnosis codes.
Essential Functions II
Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.
Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.
Other duties as assigned.
| Date Posted
June 14, 2019
| Date Closes
August 13, 2019
| Located In
| Work At
Physicians Clinic Inc
8:00-4:30 hours per week
| SOC Category