Senior Analyst, Quality
Job Description:
• Responsible for conducting complex audits, reviews and assessments of medical records coded by internal teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS)
• Contributes to compliance reporting and documentation, highlighting findings, recommendations, and areas of concern to be delivered to coding resources
• Demonstrated ability to apply coding judgment and make decisions using industry-standard evidence and tools
• Adhere to stringent timelines consistent with project deadlines and directives
• Serves as the training resource and subject matter expert to vendors, providers and other team members for questions regarding ICD coding and documentation requirements
• Identify and communicate documentation deficiencies to allow for continuous education opportunities for providers, vendors, and peers
• Acts as mentor to provide education to internal staff based on audit findings
Requirements:
• Minimum of 5 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
• Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required
• Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 5 years for CPC
• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder) required
• CPMA (Certified Professional Medical Auditor) or CDEO (Certified Documentation Expert Outpatient) preferred
• Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications)
• Experience with International Classification of Disease (ICD) codes required
• Expertise in medical documentation, fraud, abuse and penalties for documentation and coding violations based on governmental guidelines
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
Apply Now
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• Responsible for conducting complex audits, reviews and assessments of medical records coded by internal teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS)
• Contributes to compliance reporting and documentation, highlighting findings, recommendations, and areas of concern to be delivered to coding resources
• Demonstrated ability to apply coding judgment and make decisions using industry-standard evidence and tools
• Adhere to stringent timelines consistent with project deadlines and directives
• Serves as the training resource and subject matter expert to vendors, providers and other team members for questions regarding ICD coding and documentation requirements
• Identify and communicate documentation deficiencies to allow for continuous education opportunities for providers, vendors, and peers
• Acts as mentor to provide education to internal staff based on audit findings
Requirements:
• Minimum of 5 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
• Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required
• Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 5 years for CPC
• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment Coder) required
• CPMA (Certified Professional Medical Auditor) or CDEO (Certified Documentation Expert Outpatient) preferred
• Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications)
• Experience with International Classification of Disease (ICD) codes required
• Expertise in medical documentation, fraud, abuse and penalties for documentation and coding violations based on governmental guidelines
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
Apply Now
Apply Now