Supervisor, HCC Analysts

Summary

Supports TMs and their key objectives to drive capture of correct risk adjustment coding including documentation improvement, provider education, report analysis and identifying process improvements. Will also be responsible to provide continuing education as well as mentor new hires, create training materials and deliver training by in-person, virtually or webinar venue. Will conduct data analyses identifying opportunities to improve provider documentation and accuracy of chronic health condition. Required cross team collaboration for all team projects, including provider outreach, education and analysis. May requires driving to Southern CA clinics and provider offices approximately 30-40% of time. Reports directly to VP, Quality Management. [NOTE: As a healthcare provider with possible onsite responsibilities, MPM requires applicant to be fully COVID vaccinated.]

Duties and Responsibilities:

• Oversees HCC coding on projects for MA and ACA including the ability to quickly flex between coding projects.
• As needed, review and audit medical records at provider offices/clinics to identify coding risk areas and ensure that training activities are addressing these areas.
• Review records for completeness, accuracy and compliance with regulations.
• Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding.
• Assist with regulatory audit reviews by performing first coding review and ranking of charts.
• Build partnerships and work with coding teams and internal partners critical to HCC training.
• Participate on ad-hoc projects per the direction of leadership to address the needs of the sub-department. Provide recommendations for process improvement and efficiencies.
• Active participant in health plan quality and JOM meetings including preparation of updated IPA information and performance.
• Conduct data analyses from medical record reviews, create specialized provider education by identifying opportunities to improve documentation and accuracy of chronic conditions.
• Create and review HCC training materials for teammates and external provider community.
• Using independent judgement and sensitivity, review with individual physicians and clinic administrators their audit findings and make suggestions for coding improvements.
• Provide written documentation of potential HCC codes to providers at the point of care while ensuring accuracy of coding and documentation.
• Resolve or clarify codes or diagnoses with conflicting, missing or unclear information by consulting with providers.
• Provide expertise in reviewing and assigning accurate medical diagnoses codes for a wide variety of clinical cases based on services performed by physician and other qualified healthcare providers in the office or clinic setting.
• Maintain a professional and supportive working relationship with clinic staff, health plan staff, administration and physicians.
• Demonstrate high level of proficiency with documentation review including review of orders/results for lab, imaging, hospital records, EHR, etc. as a possible source for HCC codes.
• Work with offices to coordinate completion of Annual Wellness Visits (AWV) for Medicare and Covered CA members.
• Identifies training needs; prepares training materials and conducts coaching and training as appropriate for clinic staff, physicians and other staff to improve the quality of the diagnosis documentation and accuracy of the collection and coding of members’ health data.
• Prepares updated reporting for Board Meetings.
• Performs miscellaneous job-related duties as assigned and requested.
• Sub-department hiring, firing and preparation of teammate evaluation functions.

Minimum Job Requirements:

• Bachelor’s Degree or equivalent experience in finance/business, medical records technology, health services administration, nursing or other ancillary medical area.
• Certification in one of the following: Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS) and three or more years of coding experience. (within physician practice, health plan, IPA or MSO setting preferred)

Knowledge, Skills and Abilities Required:

• Strong written and oral communication skills.
• Proficiency with Microsoft Office Programs; primarily Word and Excel 2013 or higher
• Demonstrated expertise with CPT, ICD-10-CM, medical anatomy and terminology in assigning accurate diagnosis coding
• Sound knowledge of medical coding/billing guidelines and regulations including compliance and reimbursement
• Working knowledge of Medicare risk adjustment principles and audit processes
• Ability to work under pressure and respond appropriately in all situations
• Ability to establish and maintain effective working relationships with physicians and staff
• Willingness to collaborate with peers to enhance teamwork and performance of all Clinic functions
• Current CA Driver’s license with current auto insurance
• EZ-CAP® knowledge a plus.