Medical Record Reviewer will primarily be responsible for completing medical record reviews (on-site, remote and/or in-house) in support of the Medicare risk adjustment retrospective initiative and Risk Adjustment Data Validation (RADV) Audits. This role will also assist with building the medical chart review program at Client’s
Duties and Responsibilities
- Utilize comprehensive knowledge American Hospital Association (AHA) coding principles of CPT, HCPCS, ICD9-CM/ICD10-CM diagnosis and procedure codes to evaluate medical record documentation for HCC risk adjustment related activities including Medicare Advantage and Commercial Risk adjustment supplemental diagnosis capture, Medicare and Commercial RADV support, and the auditing of Client’s medical chart retrieval and coding vendors.
- Collect and document chart and coding information as required for Commercial Risk Adjustment and Medicare Advantage Risk Adjustment Client’s data collection procedures and systems.
- Assist with building the medical chart review program at Client’s including defining the operating policies and procedures, mentoring team members and input into infrastructure needs and organization.
- Utilize coding expertise to inform Revenue Management strategy development activities and may support initiatives related to coding such as provider office education.
- Responsible for developing and maintaining internal and vendor based coding guidelines.
- Provide subject matter expertise on projects related to coding practices including provider education and communications.
- Prepare reports of the data gathered and received from Client’s providers/members, ensuring reports are completed with the highest quality and integrity and that all work is in full compliance with Client’s and Regulatory requirements.
- Participate in all required training - maintaining of coding certification or other professional credentials
- Completing inter-rater reliability testing as requested
- Abide by all HIPAA and associated patient confidentiality requirements.
- Coordinate with third party and internal auditors as required.
- Other duties and projects as needed.
Minimum Requirements
- Bachelor's Degree; Clinical experience or licensed nursing professional and 3-5 years related experience. RHIA, RHIT, CCS or CPC-H with demonstrated outpatient coding experience required. ICD -9/ICD-10 certification required.
- Experience in performing HEDIS chart abstractions; Experience in Risk Adjustment audit HCC extraction.
- Experience of healthcare delivery systems is preferred. Proven project leadership skills and ability to mentor and motivate others in the team.
- Advanced PC skills (e.g., Excel, Access, etc.) required; Excellent written and verbal communication skills, customer service skills, organization and problem solving skills, research skills, and the ability to work independently.
Thanks & Regards
Dishant
781-684-9064
