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HCC Risk Adjustment Specialist

Methodist Health System Omaha, NE

Job Description

  • Purpose of Job
    • Increases revenue/avoids loss by capturing quality indicators (Healthcare Effectiveness Data and Information Set - HEDIS) and Medicare Risk Adjustments (MRA) to improve accuracy and completeness of Cerner problem to list to reflect chronic conditions per Centers of Medicare and Medicaid Services (CMS) Hierarchical Conditions Categories (HCC) guidelines. Assists with risk adjustment score improvement and increased physician satisfaction.
  • Job Requirements
    • Education
      • Graduation from an accredited LPN school required. RN preferred.

    • Experience
      • Minimum 3-5 years clinical experience required.

    • License/Certifications
      • Current Licensed Practical Nurse (LPN) licensure required.

    • Skills/Knowledge/Abilities
      • Strong clinical knowledge related to chronic illness diagnoses.
      • Excellent understanding of clinical documentation requirements in order to support an active diagnosis.
      • Knowledge of medical terminology, anatomy & physiology, and medical prescription & over-the-counter drugs used to treat conditions.
      • Ability to communicate effectively both verbally and in writing.
      • Computer literate in Microsoft Office Suite and coding application used in functional area.
      • Detailed oriented.
      • Ability to plan, organize, prioritize, and work independently.
      • Demonstrated ability to meet and exceed productivity and quality expectations.
      • Knowledge of CMS HCC guidelines and application relevant to improved documentation and favorable reimbursement.
      • Ability to assess and take appropriate action with little guidance.
      • Ability to build and maintain physician collaboration and satisfaction through communication and consistent customer services practices.
  • Physical Requirements
    • Weight Demands
      • Sedentary Work - Exerting up to 10 pounds of force. Sitting most of the time. Walking and Standing are required only occasionally.

    • Physical Activity
      • Not necessary for the position (0%):
        • Climbing
        • Crawling
        • Kneeling
      • Occasionally Performed (1%-33%):
        • Balancing
        • Carrying
        • Crouching
        • Distinguish colors
        • Lifting
        • Pulling/Pushing
        • Standing
        • Stooping/bending
        • Twisting
        • Walking
      • Frequently Performed (34%-66%):
        • Fingering/Touching
        • Grasping
        • Reaching
        • Repetitive Motions
        • Speaking/talking
      • Constantly Performed (67%-100%):
        • Hearing
        • Keyboarding/typing
        • Seeing/Visual

    • Job Hazards
      • Not Related:
        • 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)
        • Equipment/Machinery/Tools
        • Explosives (pressurized gas)
        • Electrical Shock/Static
        • 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.

Job Details

Date Posted June 14, 2019
Date Closes August 13, 2019
Requisition 12997
Located In Omaha, NE
Work At Physicians Clinic Inc
Department Coders
Shift Daytime
Hours 8:00-4:30 hours per week
SOC Category 00-0000.00