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Overview

The HCC Coding Quality Analyst is responsible for delivering educational seminars and/ or content to all primary care practices associated with Independent Health. The Analyst is responsible for the targeted delivery of information to primary care practices who have been identified through performance reports as having significant improvement opportunities. The Analyst is responsible for multi-channel education including, but not limited to, face-to-face provider education, which includes on-site coding (HCC and CRG) and documentation education of identified provider offices, use of the EMR to assist in appropriate coding and documentation or other pertinent education on HCC and CRG coding that is needed. The HCC Coding Quality Analyst is also responsible for bringing forward to practice manager(s) any issues or concerns identified in the practices. The Analyst is responsible for the practice implementation of the comprehensive process aimed at using metrics to improve the provider practice scorecard in the areas of coding and documentation. The incumbent is also responsible for assisting in the claims review, medical record capture and review, and identification of the one best record to verify CMS HCC submission as assigned per CMS RADV audit specifications. The Analyst is going to assist the manager in training coding integrity associates and provide coaching and mentoring as needed.

Qualifications

+ Associates degree required. Bachelor’s degree preferred. Two (2) years of relevant experience may be considered in lieu of degree.

+ AHIMA (CCS-P)/AAPC (CPC) certification and/or RHIA/ RHIT degree required. Degree preferred.

+ Three (3) years of experience in medical record auditing, with a focus on ICD-9 and ICD-10 coding verification required.

+ Experience in provider education preferred.

+ Experience in medical record auditing for prospective or retrospective CMS HCC capture preferred.

+ Proven knowledge of established documentation and coding guidelines as per CMS/AMA standards.

+ Demonstrated analytical and critical thinking skills, with the ability to apply knowledge of coding guidelines to analyze clinical/claims data and identify opportunities for intervention.

+ Demonstrated excellent verbal, written and interpersonal communication skills with the ability to effectively communicate with both internal and external customers in a professional manner on a daily basis.

+ Ability to prepare quantitative and qualitative summary reports at the conclusion of medical record audits.

+ Demonstrated strong organizational skills, with the ability to effectively manage practice audit/education workload.

+ Demonstrated experience utilizing independent judgment to render decisions.

+ Demonstrated time management skills, with the ability to work in a self-directed, autonomous manner.

+ Demonstrated PC/Windows skills with proficiency in Microsoft Word, Excel and Powerpoint required.

+ Local travel required. Any Independent Health associate who uses a motor vehicle in the course of their duties representing Independent Health must be compliant with New York State Motor Vehicle laws and must follow the Policy that pertains to Driver’s License Requirements as a condition of employment.

+ Ability to work a flexible schedule required.

+ Proven examples of displaying the IH values: Passion, Caring, Collaborative, Respectful and Accountable.

+ Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.

+ Other duties as needed. Every associate is given a job description upon hire outlining the qualifications, duties, and pay grade of the position. Independent Health reserves the right to change job descriptions as necessary.

Essential Accountabilities

+ Responsible for the targeted delivery of information to primary care practices who have been identified through performance metrics reports as having significant improvement opportunities Responsible for the delivery of multi-channel education of identified provider offices on coding and documentation as it relates to capture of HCCs or CRGs, use of the EMR to assist in appropriate coding and documentation, adapting pre-visit planning techniques to appropriate capture HCCs or CRGs, or other pertinent education on coding that is needed.

+ Responsible for the practice implementation of the comprehensive process aimed at using metrics to improve provider practice scorecard in the areas of coding and documentation.

+ Bring forward to practice manager(s) any issues or concerns identified in the practices.

+ Answer escalated phone calls from servicing and/or providers or office staff to address questions about coding and documentation; or provide feedback on audit results when indicated.

+ Responsible for in-house medical record reviews from faxed in, mailed in, or emailed medical records, and practice-based medical record reviews of the electronic medical record or paper record, to identify HCC or CRG codes, and the identification of missing key gaps in care, in accordance with documentation & coding standards and clinical practice guidelines.

+ Provide feedback regarding vendor performance; and participate in calls with affiliates or vendors as requested by manager.

+ Analyze claims submission and RAPS data from an IBM Cognos database to identify areas of opportunity for which to review medical records in the provider network to find revenue generating diagnosis codes (HCC’s).

+ Create weekly report of referrals to CM/DM/BHCM for distribution to appropriate areas.

+ Maintain an on-going, flexible professional working relationship with the provider offices in the community that have been assigned per practice manager.

+ in the claims review, medical record capture and review, and identification of the one best record to verify CMS HCC submission as assigned per CMS RADV audit specifications.

+ Assist the manager in training and performing quality assurance audits of coding integrity associates. Provide coaching and mentoring as needed.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $32.50 - $37.50 hourly

_Compensation may vary based on factors including but not limited to skills, education, location and experience._

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

_As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law._ _Click here (http://www.independenthealth.com/about/careers/additional-eeo-aap-information)_ _for additional EEO/AAP_ _or Reasonable Accommodation_ _information._

Current Associates must apply internally via the Job Hub app.

The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.

Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community.

We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog.

We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here (http://www.independenthealth.com/about/community-report) to view our Community Reports.

Apply today and join us on the journey to a happier, healthier, and more inclusive community.

We are a drug-free workplace. We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: [email protected] or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.

_Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us._