Responsibilities
- Deliver virtual training sessions to individual providers and large medical groups using the HCC Risk Adjustment model
- Instruct healthcare providers on the principles of risk adjustment and current best practices in documentation and coding
- Evaluate coding performance metrics and audit error trends to identify clinical areas or providers needing focused review
- Conduct in-depth prospective and retrospective audits of medical records to verify ICD-10-CM coding and HCC accuracy
- Ensure all audited records comply with CMS documentation standards, including MEAT criteria (Monitor, Evaluate, Assess, Treat)
- Maintain data integrity, regulatory compliance, and accurate risk scoring through thorough chart audits
- Use compliant query methods to resolve unclear, conflicting, or incomplete clinical documentation during reviews
- Produce detailed reports on audit findings, coding errors, and accuracy rates to highlight patterns of under-coding or over-coding
- Analyze electronic health records and claims data to detect gaps in care and opportunities to recapture chronic condition diagnoses
- Determine training needs and schedule educational sessions with individual providers and practice groups
- Provide instruction on optimizing EHR workflows to support accurate coding and documentation for confirmed and suspected conditions
- Demonstrate expert-level understanding of provider documentation and coding practices within EHR systems
- Meet established performance metrics and achieve quarterly goals
- Serve as the internal authority and escalation contact for risk adjustment and coding documentation issues
- Follow all documentation, coding, and legal guidelines to ensure adherence to federal and state regulations
- Carry out additional related responsibilities as assigned, even if not explicitly listed
Work Arrangement
Hybrid
