The Senior Coding and Risk Adjustment Analyst is responsible for developing, implementing and maintaining physician, mid-level and CPC coder patient medical record coding for disease burden accuracy, quality, and overall provider education strategies around coding initiatives. The Senior Analyst will work to create reports and education materials to drive complete consistent coding, across the Innovatus Health Network, while managing a group of professional coders.
Additional job responsibilities may include but are not limited to:
Serve as a Subject Matter Expert to internal and external stakeholders across Innovatus Health in Commercial as well as Direct to Employer payor arrangements
In conjunction with leadership team develop a strategy for coding education through data and develop measurable action plans for provider(s) not meeting targeted coding accuracy goals
Deliver on organization and client Quality goals in a highly matrixed work environment
Steer centrally-administered education campaigns to result in efficient and effective outreach efforts
Regular meet with administrative leads in the Innovatus Health Network to review current progress toward goals
Maintain knowledge of current professional, regulatory, and industry trends to consult with internal and external stakeholders on standards and best practices.
Support prospective partner presentations on the Quality value proposition in conjunction with business development efforts
Experience with payers and billing including knowledge of ICD-10 coding guidelines
Demonstrated track record for achieving performance results
Ability to analyze and present data
Excellent written and oral presentation skills, with the ability to engage, inspire, build credibility and engender trust across all levels of an organization
Abides and demonstrates Standards for Ethical Coding as set forth in certifications.
Attends workshops and brings back information appropriate to departments impacted by professional billing/coding. Keeps abreast of coding changes and technology.
Demonstrate competency in use of technology and publications for coding research, HIPAA compliance and other issues impacting coding functions in professional billing/coding.
Maintain certifications necessary to provide professional billing coding support to healthcare professionals to include maintaining or obtaining Healthcare Compliance certification if requested by the hiring department.
Additional Experience Requirements:
Experience working with physicians directly
Coding experience in HCC, RAF, ACO, CIN
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Degree/Diploma ObtainedProgram of StudyRequired/
Minimum Years RequiredArea of ExperienceRequired/
Preferredand/or3 YearsOutpatient CodingRequiredand2 YearsSupervisor/ManagementRequired
3 to 5 years ACO, CIN, Value based experience
State of Florida Licensure Requirements
Ability to efficiently use paper handwritten charts, electronic medical records, Evidence of adult education work history.