ABOUT NCH
NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.
NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.
JOB SUMMARY
The Risk Adjustment Analyst position is responsible for supporting quality improvement and star rating measures established by CMS and other value-based quality contracts. Performs clinically based health record reviews to facilitate and obtain appropriate provider documentation for clinical conditions and procedures to reflect severity of illness, accurate coding, expected risk of mortality, accuracy of patient outcomes, and complexity of patient care. This role provides quality specific education to providers and support staff of the NCH Medical Group in a variety of ways including direct interactive learning in individual or group settings, written guides and protocols, audits, etc. This role is responsible for building relationships with the clinical and clerical teams to ensure open communication for questions concerning the quality programs the NCH Medical Group is enrolled in. The Risk Adjustment Analyst will facilitate and provide detailed analysis, reporting, and support to providers and staff to promote accurate clinical documentation along with HCC/Quality opportunities identified via performed analysis.
ESSENTIAL DUTIES AND RESPONSIBILITIES
– Other duties may be assigned.
· Conduct medical record audits for physicians (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes related to chronic conditions.
· Knowledge of ICD-10-CM and CPT coding conventions, and clinical documentation.
· Creates Provider scorecards to offer feedback on Risk Adjustment methodology.
· Analyze coding patterns within the NCH Medical Group.
· Develop customized risk coding education and educational materials for providers, as well as clinical and clerical support staff.
· Travel to NCH Medical Group offices at least two days a week to provide continual education on risk adjusted codes and the impact these codes have on the value-based programs the NCH Medical Group is involved in.
· Develop, deliver, and performance manage provider insights for essential Risk-relevant initiatives related to HCC accuracy, recapture, and successful submission.
· Participate in additional audit activities as needed, including retrospective chart reviews.
· Demonstrate an understanding of the Medicare Star Rating program.
· Effective project plan development, maintenance, and management.
· Logging, tracking, and ensuring completion of all key project milestones.
· Accountable for reviewing patient records to accurately maximize risk scoring in keeping with risk adjustment strategies.
· Research complex coding HCC issues and keeps abreast of coding and compliance changes as communicated by CMS, HHS, AHA, AMA and the Federal Register, and sharing knowledge with co-workers, as directed.
· Protects data integrity and validity.
· Maintains and respects patient confidentiality for accessing and disclosure of health information.
· Knowledge of and compliance with standards of ethical coding as set forth by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).
· Knowledge of anatomy, physiology, pathological processes of disease, and medical terminology.
· Critical thinking skills for chart review and abstraction.
· Efficient Time Management skills.
· Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and Quality.
· Proficiency in use of Microsoft applications such as Word, Excel, and PowerPoint.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
· Assocaite's degree or equivalent from two-year college or technical school; or three years related experience and/or training; or equivalent combination of education and experience.
· Certified Risk Adjustment Coder or similar.
· Familiarity with Medicare Advantage and the Medicare Star Rating program, especially areas such as customer service, provider service, pharmacy, CAHPS, HOS, and HEDIS.
· Knowledge of CPT and ICD10 codes.
· Knowledge of basic and specialty specific medical terminology.
· Ability to perform multiple tasks simultaneously, work under pressure, and meet critical deadlines.
· Must possess a high degree of professionalism and business ethics.
· Ability to work autonomously with little to no daily supervision while demonstrating continual progress and effective management of projects / interventions.
· Excellent verbal and written communication skills with ability to effectively articulate and explain required information to patients.
· Clinical experience preferred but not required.
· EPIC experience preferred but not required.
