Role: Medicare Risk Adjustment Coding & Documentation Specialist
Assignment: Medicare Risk Adjustment
Location: Denver, CO (Centennial)
This role is responsible for conducting prospective and concurrent reviews for the Medicare Risk Adjustment organization to identify documentation improvement opportunities. In this role you will be working collaboratively with Humana’s providers, coder, and/or office staff performing coding and review onsite. This role reports to the Coding Frontline Leader to communicate updates and feedback from the program designed to ensure all diagnoses are coded, documented and properly supported in the patient chart according to CMS and Humana risk adjustment coding guidelines. Work will require 50% travel.
Key Role Responsibilities
- Provides review of clinical records; identifies gaps in clinical documentation that need clarification for accurate code assignment to ensure the documentation accurately reflects appropriate information.
- Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity.
- Actively communicates with providers at all levels, to clarify information and to communicate documentation requirements.
- Provides face-to-face educational opportunities with providers (2 -3 days per week provider facing)
- Perform chart review and identify previously accepted/undocumented conditions to accurately report patient’s true health status.
- Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes.
- Actively engages with Frontline Leader to communicate updates and feedback to ensure all diagnoses are coded, documented and properly supported in the patient chart according to CMS and Humana risk adjustment coding guidelines.
- Prior coding experience in Medicare Risk Adjustment/HCC, 2+ years
- Knowledge and experience in health care environment/managed care
- Must have CPC certification
- Knowledge of EMR for reviewing records
- Must be comfortable communicating & working closely with providers
- Strong understanding of Microsoft, Word, Excel, PowerPoint and work related software
- Ability to handle multiple tasks and deadlines with attention to detail
- This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
- Health Plan experience
- Additional Certifications are preferred: CRC, CPMA, CPCI, RHIT,RHIA etc
- Knowledge of billing
- Strong collaboration and relationship building skills
- Ability to learn new tasks and concepts
You will report to a Frontline Leader. This area is under the leadership of the SVP & Chief Financial Officer
Provider facing role 2-3 days per week in the local market.