Join our team and contribute to helping achieve the triple aim of healthcare, improving the experience of care, improving the health of populations, and reducing per capita costs of health care.

Think you have what it takes? Apply here.

Think you have what it takes?Apply here.

Optimus Health Analytics is hiring energetic and driven professionals to lead the healthcare industry towards a data-driven future.

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