- Full Time/Contract
- Beverly Hills, CA
Since 1902, our Client’s hospital has focused on providing the highest quality healthcare available and in 2009 was named one of "America’s Best Hospitals . Today, our client delivers word-class medicine to the Los Angeles community and to patients from across the United States and around the world.
HCC RA Education Specialist
The HCC RA Education Specialist is responsible for reviewing chart notes for proper code assignment with an emphasis on provider education, by improving documentation and coding to facilitate revenue capture. The specialist provides education to clinicians, clinic staff, and others as needed via face-to-face meetings, classroom settings and webinars. Also develops, maintains and presents coding and compliance educational materials to staff and clinicians. The specialist collaborates with the Sr. Manager of HCC RA Physician Coding Education to support the needs of PBS where coding expertise/education is needed. This position is also responsible for analysis and assessment of governmental payer audits, conducts focused reviews and monitors provider compliance with medical record documentation after training and education.
QUALIFICATIONS / REQUIREMENTS
- Acts as documentation and coding liaison to clinicians to include review, education and necessary follow-up to help ensure that clinical documentation and coding services meet government and organizational policies and procedures.
- Analyzes and provides education on revenue capture, clinical documentation coding accuracy to clinicians and clinic staff.
- Assists in determining educational needs based on documentation reviews, provider/staff feedback, data analysis (bell curves).
- Reviews Clinical chart for suspected conditions to be suggested to the provider to improve documentation, coding and improving provider RAF scores.
- Responsible for sending coding reports to providers received from coding vendor resources
- Communicate directly with providers on coding feedback and chart review findings
- Prepares necessary reports out of MDX and communicates results to management, clinicians, and committees as appropriate.
- Reports areas of risk directly to the Sr. Manager HCC RA Physician Coding Education.
- Maintains a high level of competency related to clinical documentation and coding in assigned specialty and other areas and compliance with government regulations by attending appropriate workshops and seminars.
- Monitors Medicare Advantage and other rules for updates and changes.
- Uses spreadsheets to log physician performance results and to re-educate on those outstanding issues and trends.
- Attends seminars and workshops, as applicable, for updates on new coding rules and regulations.
- Participate in decision making concerning policies and procedure as requested
- Meets organizations objectives set by leadership.
- Understands coding trends by billing area, location, and provider for all groups and physicians.
- Handles in a professional and confidential manner all correspondence, documentation, and files.
- Supports CSMNS core values, policies, and procedures.
- Ensures policies and procedures pertinent to the coding and compliance departments
- Bachelor’s Degree preferred or International Medical Graduate Doctor with experience in chart reviews preferred.
- Minimum of three years’ coding experience in advanced professional multi-specialty specific HCC, ICD-10 codes required.
- Minimum of two years’ experience in chart audits/reviews/education and training required.
- Demonstrated experience serving in a consulting or advisory role with regard to coding compliance.
- CPC certified (preferred)
- Exhibit high degree of accuracy and attention to detail in all documentation and correspondence
- Understands various reimbursement initiatives that are impacted by documentation and coding, including Medicare Advantage and Commercial.
- Knowledge of policies and procedures, as well as data flows in a health care organization; experience with HCC RA preferred.
- MS Word and Excel expertise.
- Excellent presentation skills preferred.
- Ability to work independently with minimal supervision
- Excellent verbal and written communication skills in the English language.
- Understanding of computer systems, as well as knowledge of computer programs such as Word and Excel; understanding of Epic preferred.
- Must be able to perform critical work under deadlines
- Ability to work in a changing environment and handle multiple tasks
- Ability to prioritize work, time sensitive reports and projects
Demonstrates behavior, which supports the Health System mission. Attends required orientation and training seminars. Work product and performance meets quality standards. Demonstrates respect and positive interpersonal skills with patients, clients, the public, managers, and co-workers. Is a team player. Maintains confidentiality of patient care and business matters. Observes time, attendance, and dress code standards. Protects the safety of others and of the physical plant and equipment, following institutional policies, fire, safety, and infection control regulations.
$40hr – $45hr