Job Overview: Responsible for conducting retrospective and concurrent medical reviews to assess medical record documentation and monitoring codes on claim/encounters for Medicare Risk Adjustment.
Primary duties include, but are not limited to:
- Conducting concurrent medical record and claims review to assess medical record documentation practices and accuracy/sufficiency of policies and procedures.
- Verifying accuracy/appropriateness of submitted diagnosis codes based on medical record documentation looking at both ways:
1) relevant detail in the medical record is not captured in what is reported, and
2) when details in the medical record do not support reported information.
- Providing feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
- Developing and implementing action plans to address issues identified through data analysis.
- Providing oversight, guidance, and training to partner providers and clinicians related to CMS guidelines and HCC best practices.
- Developing training programs and tools; performs internal process and policy audits.
- Conducting ongoing review, monitoring, and communications to promote and ensure adherence to established protocols and best practices.
- Reviewing documentation of well visits (annual well visits and other routine and preventative visits), including the use of appropriate modifiers for telehealth visits, HEDIS scoring accuracy, etc.
Qualifications:
- Requires a minimum of 1-year experience with all types of medical records (including Medicare Risk Adjustment and evaluation and management coding) in a physician practice setting or large group practice, and includes educating providers on clinical documentation needs.
- Certified Clinical Documentation Specialist (CCDS, CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Improvement Professional (CDIP) preferred.
- Current Certified Professional Coder certification (CPC, CPC-H, CCS, CCS-P, or CRC) preferred.
- Additional experience in clinical diagnostic coding is preferred. Clinical experience or background (e.g., RN, LPN, foreign medical graduates) preferred.
- Travel within NYC to various PCP offices in our network is required as needed.
Please send your resume at contact@optimusha.com