Job Description
Job Description
Description :
The Value Based Risk Adjustment Coding Advisor supports coding accuracy, medical record documentation, quality gap closure and provider education in the Community Health Clinics (CHC’s) participating in the CHPA Accountable Care Organization. The personnel in this position will use their knowledge of risk adjustment coding, documentation guidelines, and report generation to assist in any coding and auditing related functions determined by their direct supervisor or CCMCN leadership.
Responsibilities :
The Value Based Coding Advisor will interact with operational and clinical leadership to assist in the identification of Risk Adjustment / HCC coding opportunities, and will provide targeted education to CHC providers, billers, coders, and support staff to support value-based contract initiatives.
Risk Adjustment / HCC Coding Support and Education
- Educates providers and staff on coding regulations and changes as they pertain to risk adjustment and quality reporting to ensure compliance with federal and state regulations.
- Assist the department, direct supervisor and CHPA in the development of education tools related to risk adjustment / HCC coding and gap closure.
- Supports the creation of education that will train CHC providers, billers, coders, and support staff, as well as CHPA staff, for risk adjustment / HCC coding opportunities.
- Maintains a database with the results of all medical chart reviews performed, with ability to report on progress and statistics on coding initiatives.
Pre-Visit Planning (PVP)
Performs weekly Pre-Visit Planning reviews for assigned CHC’s and will query providers or other identified team member to furthervalue-based contract initiatives including coding recommendations based on internal and external medical records, review of payer portals and suspected conditions, and review of care gap and clinical documentation.
CHC Support
Holds monthly meetings with identified coding champions, provide education and training to CHC providers, billers, coders, and support staff in proper coding guidelines; and documentation education based on PVP observations and monthly topics.Provides monthly chart reviews of randomly selected patients and providers participating in Pre-Visit Planning (PVP) program to give feedback on missed opportunities and errors.Gap Closure Success
Reviews patient charts to identify areas for quality gap closures and provide compliant documentation to appropriate payers resulting in gap closures for assigned CHC’s.Ensures that providers understand CPT II coding for the purposes of quality gap closure and reporting.CCMCN Success
Assist in all CCMCN dashboard and scorecard initiatives to improve performance outcomes.Assist supervisor in implementing best practices, policies, and procedures to increase support services to the CHCs we serveAssist in developing and sharing guidelines / best practices with internal risk adjustment coders to help improve coding documentation techniques for our membersHelps with special projects within Risk Adjustment DepartmentRequirements :
To achieve high-quality outcomes the Value Based Coding Advisor is to have knowledge of HEDIS / STARs measures and guidelines, CMS Hierarchical Condition Category (HCC) coding guidelines, clinical documentation standards, and education / training skills.
High School diploma or equivalent.Minimum 2 years coding experienceThe American Academy of Professional Coders (AAPC) Certified Risk Adjustment Coder (CRC) certification is required; Certified Professional Coder (CPC) Certification will be considered with Risk Adjustment / HCC Coding experience and willingness to obtain CRC within 1 year of employmentRisk Adjustment experience required.FQHC billing experience is highly preferredExperience with clinic billing and coding requiredKnowledge of several EHR systems preferred (ECW, Athena, Greenway Intergy, Epic).Clinical background preferredStrong knowledge of CMS coding and quality guidelines.Strong knowledge of PowerPoint, excel and Microsoft word with the ability to manipulate basic information and data required for preparing reports and delivering training.Exceptional interpersonal, public speaking, and presentation skills to deliver training and education is preferred.Ability to facilitate group discussions that challenge participants and promote discussion of new approaches and solutions based on data and value-based care initiatives.Ability to adapt to changing initiatives and priorities based on the needs of CCMCN and the CHC’s success.Ability to professionally communicate and manage conflict with others in both an internal and external setting.Ability to work independently and to self-motivate to complete tasks; resourceful and proactive.Fluency in written and spoken English, with reading comprehension skills.Displays cultural competence in diversity, equality, equity, and inclusion to fit CHPA’s cultural values and mission.Ability to travel to and within the state of Colorado- 25% travel within the state of Colorado with an unrestricted driver’s license and an insured vehicle.Proof of full COVID- 19 vaccination may be required for employment.Home office that is HIPPA compliant and has high speed internet capability.Mobile device for work purposes.Working Environment and Physical Activities
Hybrid position- work from home with 25% travel capability.This position requires several hours of travel to meetings in the state of Colorado.Insured group health, dental, & vison plans (NOTE : Medical Insurance may not be available for out of state employees)Medical and dependent care flexible spending account options401k retirement plan with an employer contribution matchLife, AD&D, and Long-term disability plans paid for by employerFree 24 / 7 access to confidential resources through an Employee Assistance Program (EAP)Voluntary benefit plans to complement health care coverage including accident insurance, critical illness, and short-term disabilityA generous mix of vacation, sick and holiday paid days offCCMCN is an equal opportunity employer with a policy that provides equal employment opportunity for applicants and employees regardless of race, color, religion, disability, gender, age, national origin, sexual orientation, gender identity, marital status, pregnancy, veteran status, or any other classification protected by law. This policy applies to all aspects of employment, including recruitment, hiring, promotion, compensation, reassignment, layoff, discharge, education, training, and all other working conditions.
