Risk Adjustment Coding Specialist

Risk Adjustment Coding Specialist : Central Valley Medical Providers in Fresno, CA

Position Summary : A great opportunity to workdirectly with a dynamic all-physician Board of Directors and talentedmanagement team to support the clinical needs of the fastest growing IPA inthe Central Valley, serving Fresno and Madera Counties. Under the supervisionof the Director of Operations, the Risk Adjustment Coding Specialist will beprimarily responsible for partnering with providers and clinic operationsstaff to support CVMP's Clinical Document Improvement (CDI) program and RiskCoding initiatives.

Duties and Responsibilities

• Collect appropriate data from IPA network providersfor HEDIS measures to close HEDIS & Star Measure gaps shared byhealth plans
• Advise and educate providers on CMS guidelines forStar Measures and appropriate documentation and coding for HEDISreporting
• Collect and review medical records and ensureaccuracy of documentation for reporting
• Collect, summarize, and trend provider performancedata to include provider education
• Participate in ongoing discussions concerning datacollections and analysis for HEDIS gap in care
• Assist in the planning and implementation of projectsto improve the delivery of services and the quality of care
• Understand the principles of HIPAA and maintain the confidentialityof patient health information
• Understand the principles of CMS, HEDIS, NCQA, andmore
• Communicate internally and externally as needed togather necessary data
• Promote a positive working relationship with allstakeholders
• Attend IPA and health plan meetings as required
• Respond to primary care offices and health planquestions / inquiries promptly
• Perform other duties, projects, and actions asassigned

Qualifications and / or Experience :

PrimaryLocation : Fresno, CA,service area : Fresno and Madera Counties

JobType : Full Time; In-office reportingposition

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