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HCC Risk Coder - CDIS
Welcome to Pathways Health Partners, the Accountable Care Organization (ACO) that's leading the charge in helping independent providers transition to Value-Based Care.
What We Do:
Medicare REACH ACO: We're at the forefront of Medicare innovation.
Medicare Advantage MSO: Providing top-notch services to our Medicare Advantage patients.
Commercial MSO: Managing care for approximately 16,000 patients across North-West/Central Florida.
Where We Operate: From The Villages to St. Petersburg, and across to Mount Dora, we've got you covered!
Our Services:
Hospital Medicine Group: Delivering exceptional care in hospitals.
Affiliated Medical Practices: Managing several top-tier medical practices.
Insurance Agency: Offering comprehensive insurance solutions.
Join us on our journey to better health and value-based care!
The Clinical Documentation Specialist/Medical Coder plays a vital role in coordinating and supporting retrospective and concurrent chart reviews while providing education and facilitating chart retrieval for Health Plan audits and reports. This position requires a comprehensive understanding of Hierarchical Condition Categories (HCC) coding to accurately translate, input, extract, and validate medical record data.
- Review and assess documentation to accurately translate chronic conditions into the appropriate diagnosis codes from inpatient and outpatient medical records.
- Extract data for Health Plan reports and input data collected from HCC programs.
- Coordinate audits of Provider coding data, including scheduling audits, sending providers the list for chart reviews, and providing follow-up communication.
- Assist in obtaining medical records from Providers to support audits requested by Health Plans.
- Help coordinate training sessions for Physicians and staff on relevant coding guidelines and compliance standards.
- Review provider documentation to verify that HCC codes are accurate and meet required documentation guidelines.
- Assign appropriate ICD-10-CM codes that map to risk adjustment models and identify documentation discrepancies, querying providers for clarity when necessary.
- Participate in clinical documentation improvement initiatives and maintain regular attendance at team meetings.
- Handle special projects as assigned and perform other duties as needed.
- High School Diploma or GED. An active CRC (certified risk adjustment coder) or CPC (certified professional coder) preferred.
- CCRC/CPC highly preferred
- Understanding of regulations regarding medical coding and documentation; Administrative responsibilities, professional written and verbal communication, Typing skills. Documented training in Medicare Risk Adjustment (MRA), HCC coding documentation guidelines, rules, and regulation.
- Two years’ demonstrated experience in a medical or health plan environment
- Excellent computer skills with experience in Outlook, MS Office, MS Excel, MS Word
- Strong presentation skills, positive and effective communication skills
- Strong typing skills
Pathways Health Partners is a growing company based in Leesburg, FL. We are proud of our professional yet family culture with the executive team working daily alongside our team members. We provide competitive salaries and a benefits package that is second to none.
- Medical Insurance for Employee and Spouse/Significant Other paid up to 100% by Pathways!
- Addition of family coverage for dependents at a fraction of the cost
- 25K life insurance for employees 100% paid by Pathways!
- Increasing Employee coverage or adding spouse/dependents at a fraction of the cost
- Vision and Dental Coverage available at a very low cost for employees, spouses, and family
- 401K retirement plan with 100% match up to 4% of annual pay
- Paid holidays
- Ample Paid Time Off (PTO) for vacation/sick/personal days
We look forward to speaking with you about this opportunity!
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