Provides training and process improvement efforts across the clinical practices for the development of consistent and comprehensive clinical practices supported by the the Health Plan. Identifies process improvement opportunities associated with the management of risk adjustment initiatives. Investigates current processes, assessing efficiency and accuracy and provides solutions for problems, process improvement, development of training programs, and documentation strategies that support ICD-10 complex terminology for clinical practice operations and management. Serves as a liaison between Clinical Operations and the Risk and Revenue Management team, and facilitates communication between various constituents in order to assist in capturing chronic disease burden of the clinical enterprise patient population.
Reviews the content of the medical record professional outpatient records to identify all diagnosis codes applicable to the documentation.
Carefully reviews details of documents such as laboratory findings, radiology reports, various scanned reports, discharge summaries, history and physical, consultations, orders, progress notes and other ancillary services treatment records needed to ensure all pertinent diagnoses are recorded.
Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form using proper procedure codes as required.
Using the Encoder software program, determines the codes for all diagnoses.
Reviews and understands annual mapping of ICD-9 and ICD-10 crosswalk.
Provides education material to the RACE team to educate physicians as needed to clarify documentation within the patient's record to facilitate complete and accurate coding.
Assists in decision making relevant to physician coding education and HCC targeting purposes.
Works one-on-one with physicians as needed to verify that documentation within the patient's record is appropriate in order to facilitate accurate and complete coding.
Assumes a supporting co-educating role with regard to Risk Adjustment Education and other opportunities for internal education team and external identified opportunities.
Presents with full understanding of reports, presentations, maps and graphs, reflecting the collaboration of external and internal parties, summary and translation of data into actionable information.
Works with provider sites to define solutions to needs or problem areas, and determines scope of investigation required to obtain solutionInterprets and recommends actionable plans using financial and analytical data prepared by risk adjustment analysts.
Provides consultative support to clinical areas on a daily basis and recommends operational strategies to achieve optimal documentation and coding processes.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
*Relevant experience may be a combination of related work experience and/or completed specialty training program (1 year of specialty training = 1 year relevant experience).
If a suitably experienced candidate cannot be found, applicants who meet the basic qualifications but possess fewer years of experience will be considered for hire at a lower level. Salary would commensurate with experience.
*Work from home with travel required to sites within NorthEastern Pennsylvania
High School Diploma or Equivalent (GED)- (Required)
Minimum of 3 years-Relevant experience* (Required)
Certification(s) and License(s)
Certified Risk Adjustment Coder within 2 years - American Academy of Professional Coders (AAPC); Certified Professional Coder - American Academy of Professional Coders (AAPC); Registered Health Information Technician (RHIT) - American Health Information Management Association
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13... hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.