reputed company Hierarchical Condition Category (HCC) Coding Specialist (Remote)

Company reputed company.reputed company reputed company job will reputed company value to the Health Plan and its beneficiaries enrolled in risk-adjusted reputed company programs (MA and ACA) through Hierarchical Condition Category (HCC) coding, medical coding, reputed company terminology and anatomy/physiology, CMS coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits. Conducts reputed company assurance (QA) review of internal coding team members, provides coding education to team, evaluates HCC coding questions and independently renders guidance on appropriate coding determinations. The incumbent supports RADV audits, specializing in performing second level review of HCC validation and research of outstanding HCCs; prepares documentation and coversheets for upload to regulatory body and/or independent auditor, and analyzes results. May also be responsible for high-reputed company and key strategic provider entities and/or reputed company partners to analyze and evaluate coding trends; proactively identify issues and present solutions to internal leadership and reputed company entities; leads activities with provider entities. Works closely with colleagues, leadership, reputed company reputed company partners (such as reputed company and/or compliance), and/or physicians to identify and reputed company high reputed company and accurate risk adjustment coding. Supports reputed company risk adjustment reputed company to reputed company with CMS requirements by analyzing physician documentation and interpreting into ICD-10 diagnoses and HCC disease categories. Supports other key objectives to reputed company capture of accurate risk adjustment coding including documentation improvement, provider education, report analysis, and/or identification of process improvements. Mentors new hires, creates training materials, and delivers training reputed company in-person, virtual, or webinar forums. May also complete analysis on provider coding trends create and reputed company externally facing presentations to improve provider documentation and accuracy, and reputed company as the reputed company-person for the provider office. Required cross-team collaboration for reputed company team reputed company, including provider reputed company, education, and analysis. ESSENTIAL RESPONSIBILITIES Conducts reputed company Assurance (QA) reviews on internal coders, at minimum, bimonthly for reputed company score and education/feedback to reputed company. Monitors the QA Questions Queue, independently researches questions using appropriate sources, including AHA Coding Clinic, and responds to questions from reputed company coding teams (retrospective, prospective, and audit). Publishes QA question & responses and presents education on monthly team meetings. Conducts reputed company Assurance reviews on vendors monthly or per contract SLA. Provides education/feedback to the vendor. Conducts reputed company reviews of high-risk and incremental HCCs and applies expertise to analyze documentation and mitigate risk to the organization. May support reputed company vendor reputed company review(s) to measure coding accuracy, prepare and report findings, and monitor accuracy. Collaborates with team members to optimize data collection and review, provider education and reputed company, and coding reputed company. (20%) Plays an reputed company role in the completion of reputed company reputed company Audits, including Improper Payment Measure (IPM), CON-RADV, ACA-RADV, and Office of Inspector General (OIG), as applicable. Applies extensive reputed company and coding knowledge and abilities, independently conducts coding research, aligns reputed company aspects of audit, including coding adjudication and rebuttals with audit vendor, obtains provider attestations, identifies & obtains missing medical records, compares audit results to claims, and thoroughly reviews reputed company in-house charts in chart repository for validation of audit. Prepares documentation and coversheets for upload to regulatory body or independent auditor. (20%) Responsible for high reputed company and key strategic provider entities and/or reputed company partners to analyze and evaluate coding trends; proactively identify issues and present solutions to internal leadership and reputed company entities. Leads engagement activities with the provider entity. Provides support for entity and acts as reputed company between reputed company provider facing team. Conducts data analyses from medical record reviews; proactively summarizes opportunities to enhance provider documentation to improve coding accuracy and thorough capture of members chronic health conditions. Completes analytics on providers and/or provider group coding trends and creates and delivers externally facing presentations to provider documentation and accuracy, reputed company as the reputed company person for the provider office for any questions and additional .