Job Details

Virtua Health Coding Specialist

Evaluates and analyzes medical records for proper documentation and the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., hierarchical condition categories (HCCs), Chronic Illness & Disability Payment System (CDPS), and U.S. Department of Health and Human Services (HHS) risk adjustment). CRCs review provider documentation and communicates coding opportunities for HCC coding so that disease processes are coded accurately to follow risk adjustment models.

Position Responsibilities:

• Evaluates and analyzes medical records for proper documentation. Identifies and communicates coding deficiencies to clinicians in order to improve documentation for accurate risk adjustment coding.
• Provides on-going training and education to the clinicians and physicians during 1:1, physician group, performance improvement and ad hoc meetings.
• Manages and trends data collection for HCC and other risk coding. Performs data mining from data captured through risk adjustment coding. Works with Manager and Director of VMG Quality Department to strategize and prioritize chart reviews and education.
• Assists with the development of action plans to improve documentation.
• Completes chart reviews for various Values Based Programs focusing on annual review of suspect chronic conditions; utilizes payer portals as necessary to complete annual coding reviews.

Position Qualifications Required:

• Required Experience: Minimum of two years records coding experience or equivalent
• Ability to perform functions in a Microsoft Windows environment
• Ability to be detailed oriented and perform tasks at a high level of accuracy
• Ability to make sound decisions
• Demonstrate good communication and team work skills
• Previous experience with an electronic legal health record system
• Understand the anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses
• Understands medical coding guidelines and regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models
• Required Education: High School Diploma or GED required
• Knowledge of Anatomy & Physiology/ Medical terminology required
• Training / Certification / Licensure: CPC required
• Risk Adjustment Coder Certification (CRC) required or must obtain within six months of hire.