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Medical Coding Analyst/Educator
Arizona Complete Health
Location: Tempe, Arizona
Work Setting: Non Provider Setting
Job Function: Coder, Educator
Job Type: Full-Time
Arizona Complete Health builds upon a tradition of excellence started by Health Net of Arizona and Cenpatico Integrated Care. Health Net of Arizona was founded in Tucson in 1981 as Intergroup of Arizona, and has a proud history of serving Arizonans statewide through Medicare Advantage, employer-based coverage, Marketplace and AHCCCS. Cenpatico Integrated Care began serving Arizonans in 2005, with a special focus on improving access to community-based behavioral health services and emphasizing person-centered, whole health care for individuals.
Combine your drive for innovation with your love of helping people to improve care for millions of individuals, family, friends and neighbors.
Position Purpose: Audit vendor and internal risk adjustments coding to ensure accuracy and identify and mitigate any risks. Assist with risk adjustment data validation and other risk adjustment audits.
- Validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records
- Analyze results of risk adjustment coding validation to identify coding patterns, recommend general and specific provider education topics, and assist with the development of the communication
- Determine coding issues and discrepancies and make updates as necessary
- Identify issues, determine impact to risk adjustment models and reports results for various products and services
- Analyze claims data to identify diagnosis codes, within the risk adjustment model, to provide risk or opportunity to the completeness and accuracy of risk adjustment data
- Serve as risk adjustment coding subject matter expert for Medicare, Medicaid, Marketplace, health plans and corporate Risk Adjustment/Quality Improvement outreach operations team
- Assist with the documentation of coding-related departmental policies and procedures, both general and specific to all risk adjusted lines of business
Education/Experience: High school diploma or equivalent and 4+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry OR Associate’s degree in health related field and 3+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the healthcare industry. Experience with various risk adjustment methodology and chart audits.
Licenses/Certifications: CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA or CPMA required.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Arizona Complete Health is a subsidiary of Centene Corporation and offers great benefits including:
Posted: March 11, 2019 at 12:46 PM
Post ID: 37339