Brief job information:
The Health Management Coordinator is a mid-level position responsible for various project-based assignments which includes medical coding, clinical documentation review, assists with encounter submission responsibilities, provides administrative support to the Health Management, Quality Improvement (QI) and Pharmacy Departments. The candidate in this position provides strategic support in Risk Adjustment and Quality related initiatives.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Provides expert level review of outpatient and inpatient clinical records and identifies gaps in clinical documentation that require clarification for the accurate, complete and compliant code assignment to ensure the documentation accurately reflects the severity of the condition and acuity and risk associated with the care provided.
- In collaboration with Risk Adjustment Supervisor and IT, coordinate Medicare and Commercial encounter submissions processes to ensure all encounters are submitted by the appropriate deadline.
- Maintain reconciliation tools to evaluate accuracy and completeness of claims and encounter submissions from our contracted providers, facilities, medical groups and regulatory response files from submission vendors and CMS.
- In collaboration with Risk Adjustment Supervisor, coordinate and perform coding responsibilities for HHS Risk Adjustment Validation Audit (RADV), including all chart review of selected samples, collection of charts, and any follow-up necessary to complete the validation audit.
- In conjunction with the Clinical Documentation Improvement Specialist (CDS), assists and actively participates in the development of training materials for providers including but not limited to query/clarification templates and compliant content, PowerPoint presentations, and on/off site education guidance and mentoring.
- Requests and downloads medical charts from physician offices, contracted facilities, and EMR systems.
- Implement updates to the Risk Adjustment chart retrieval process as directed, including documenting and maintaining policies and procedures in the Health Management department to ensure coordination of operational changes.
- Provides administrative support to the HM, QI, and Pharmacy teams on project-based assignments such as HEDIS, STARS, and Risk Adjustment related initiatives.
- Under guidance from the Risk Adjustment Supervisor, responsible for Commercial and Medicare Member Incentive Program operations and fulfillment.
- Work regularly with the Director of Health Management and Risk Adjustment Supervisor to ensure efficient operational workflow on a daily basis.
- Accepts and performs other duties as assigned.
- Bachelor Degree
- Fluent in English
- Certified Professional Coder (CPC) licensed preferred
- Knowledge of both Medicare and Commercial Risk Adjustment models
- At least 1-2 year(s) experience in Risk Adjustment encounter submission processes
- Knowledge of HEDIS, STARS, and Risk Adjustment preferred
- 1-2 year(s) work experience in healthcare related environment preferred
- Able to lift up to 30 pounds
- Use proper body mechanics when handling equipment
- Standing, walking and moving 50% of the day
Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.