Responsibilities
- Lead process improvement projects by performing in-depth data and process evaluations, generating reports, reviewing medical documentation, and supporting HCC coding for healthcare members and providers.
- Gather and assess clinical data from office visits and medical records to enhance patient care, ensure accurate documentation and coding, assign ICD10-CM codes for chronic conditions, and align with revenue, credentialing, and quality programs to support STARS, value-based care, and accreditation goals.
- Track updates, corrections, and guidance from regulatory and accrediting agencies, and adapt compliance protocols to adhere to CMS Coding Guidelines.
- Perform retrospective, concurrent, and prospective audits on a scheduled and ad-hoc basis, identify deficiencies, report findings, and deliver ongoing education to providers on STARS, HEDIS, and HCC coding; conduct follow-up audits as necessary.
- Complete additional tasks as directed by management.
Work Arrangement
Remote (Worldwide)
