Job description

Equality Health is an Arizona-based population healthcare company focused on improving care delivery for underserved populations through culturally-sensitive programs that improve access, quality, and patient trust. Our mission is to ensure diverse populations receive quality healthcare that improves and enriches their lives. We have developed our product portfolio around centralized technology, services and network designs intended to organize a better healthcare delivery system for cultures that have struggled with integrating into the traditional one-size-fits-all U.S. healthcare system.
The HCC Coder is an integral part of Equality Health's risk adjustment efforts to achieve effective documentation and coding practices while maintaining and/or improving provider relationships. This individual will review submitted medical records to validate ICD-10-CMs and add recently identified ICD-10-CMs. They will deliver direct feedback to provider offices when validation cannot be completed.
Responsibilities:

• Review outpatient medical records in order to verify:
• Diagnosis codes are supported by provider documentation according to ICD-10-CM guidelines, supplemental internal guidelines, project and client guidelines
• Documentation for current management or monitoring of conditions
• Diagnosis codes unsubstantiated by the record should be eliminated
• Clinical indicators and query providers to capture the severity of illness of the patients
• Opportunities to abstract and add new diagnosis codes

• Meet and/or exceeds productivity and coding accuracy standards set by Quality Leadership
• Conduct research utilizing approved resources when needed to complete record reviews
• Delivers direct feedback to provider offices per internal policy
• Conduct practice documentation and coding audits for RAF compliance when assigned
• Ensure compliance with established protocols and procedures are maintained in the associated platforms and systems
• Ensure compliance with all applicable federal, state and/or county laws and regulations related to coding and documentation guidelines for risk adjustment
• Stay current with risk adjustment rules and regulations through regulatory agencies including (but not limited to) CMS, HHS, and OIG Workplans
• Stay current with coding, compliance and documentation guidelines
• Handle highly sensitive and confidential information in compliance with Health Insurance Portability and Accountability Act (HIPAA), and company confidentiality policies and procedures
• Support and participate in quality improvement initiatives
• Report provider documentation and submittal trends to Quality Leadership
• Demonstrate professionalism and team unity
• Other tasks as assigned per business needs

Required Knowledge, Education & Experience:

• Minimum three (3) years of experience in Risk Adjustment coding
• Must hold one or more active coding certification such as CPC, CPC-H, CCS-P, CCS, or CRC
• Proven knowledge and understanding of CMS HCC Risk Adjustment coding and data validation requirements
• Proven knowledge and understanding of medical terminology, pharmacology, body systems, anatomy, physiology, and concepts of disease processes as well as clinical practice and processes
• Proven knowledge and understanding of ICD-10-CM coding and documentation guidelines
• Proficient with Microsoft Office applications and web-based technologies
• Demonstrated ability to utilize a variety of electronic medical records systems
• Must possess high degree of accuracy, efficiency, flexibility and dependability

Highly Preferred Skills, Abilities & Qualifications:

• Proficient in HHS-HCC Risk Adjustment coding and data validation requirements
• CDPS experience
• National RAD-V experience
• Excellent verbal, written and interpersonal communication skills; highly collaborative team approach
• Strong problem-solving skills, including the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Able to convey complex or technical information in a manner that others can understand and understand and interpret complex information from others

Job Type: Full-time

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