Medicare HCC Coding Analyst, CRC Certification

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with provider partners to oversee and execute HCC coding strategies.

• Review all RAPS submissions to ensure the accuracy of data sent to CMS.

• Perform or coordinate ongoing quality audits related to coding and abstracting.

• Create, implement, assess, and enhance educational tools for IPAs that aid providers in accurately capturing both acute and chronic conditions.

• Monitor and report on the progress of coding vendor audits to guarantee coding accuracy and data quality submitted to CMS.

• Collaborate with Risk Adjustment Management on Data Validation and RADV coding audits.

• Maintain management and tracking tools for assigned IPAs within the provider network.

• Oversee Risk Adjustment activities for designated medical groups to ensure timely completion.

• Link activities, processes, and HCC results/metrics to assess outcomes.

• Ensure adherence to relevant federal, state, and local regulations as well as organizational policies.

• Assist with scheduling and training initiatives while keeping training records updated.

• Recommend Risk Adjustment coding initiatives for physician groups and participate in SCITs/education meetings.

• Coordinate Risk Adjustment audit activities for assigned groups and support CMS Data Validation efforts.

• Revise Risk Adjustment materials to reflect clinical and official guideline updates.

• Refresh educational materials in accordance with CMS-HCC Model and annual ICD-9/ICD-10 updates.

• Improve clinical educational resources for physicians and clinical staff regarding Risk Adjustment programs, clinician chart reviews, and encounter documentation.

• Tailor Risk Adjustment education for various audiences.

• Stay updated on industry coding, compliance, and HCC matters.

• Maintain professional and technical expertise through workshops, publications, networks, and professional organizations.

• Execute related tasks as necessary.

⛳️ Requirements

• At least 3+ years of coding experience in a medical group or health plan environment.

• Proven professional coding experience.

• Minimum of 1 year of experience in strategic planning for risk mitigation.

• High School Diploma or GED is required.

• Strong ability to communicate positively, professionally, and effectively; capable of providing leadership, teaching, and collaborating with others.

• Excellent written and verbal communication skills.

• Ability to build and sustain constructive relationships with diverse stakeholders, including management, employees, and vendors.

• Competence in performing mathematical calculations and accurately computing simple statistics.

• Capacity to prioritize multiple tasks and utilize advanced reasoning to identify problems, gather data, establish facts, draw valid conclusions, and develop, implement, and manage suitable solutions.

• Strong problem-solving, organizational, and time management skills; ability to thrive in a fast-paced setting.

• Proficient in understanding and analyzing statistical reports.

• Certification as a coder is mandatory.

• Experience in HCC/Risk Adjustment is necessary.

• Familiarity with Athena EHR is required.

• Must be willing to work in Pacific Standard Time.

• Previous experience with Epic, Allscripts, or EZCap is preferred.

• Completion of Certified Coder training courses is preferred.

• Proficiency in MS Office Suite is preferred; knowledge of MS Access is a plus.

• CCS, CCS-P, CPC, or Certified Auditor certifications are preferred.

🏝️ Benefits

• Comprehensive health insurance plans.

• Generous paid time off and holidays.

• Opportunities for professional development and continuing education.

• Flexible work hours and supportive remote work options.

• Collaborative and inclusive work environment.