Health Information Manager

Hcc Coding Quality Educator

The HCC Coding Quality Educator (HC) facilitates the improved integrity of medical record documentation through interaction with healthcare providers to support the appropriate representation of severity of illness, risk of mortality, acuity, and complexity of care. In addition, this position, through a multidisciplinary team approach, performs pre-visit and retrospective reviews of ambulatory clinical documentation to ensure an accurate depiction of the true complexity of the patient to support the facilities Risk Adjustment strategy. The HCQE utilizes their coding knowledge, and demonstrates an understanding of current CMS coding guidelines, the impact of procedures and compliant documentation to support the capture of Hierarchical Condition Categories (HCC), ICD-10-CM accuracy and specificity, and medical necessity. They work collaboratively with ambulatory physicians and advanced practice providers to communicate opportunities and educate members of the patient care team regarding documentation guidelines, coding requirements and service-line specific requirements. Auditing of professional records to provide education to the physicians and clinical colleagues as required. The HCQE will also ensure that all diagnoses, therapeutic interventions, and procedures codes are assigned in accordance with current ICD-10, CPT-4/HCPCS and E/M standards. Codes are assigned in compliance with CMS, NCQA, official coding guidelines, and other regulatory agency standards. Other duties assigned will be responsible for managing the entire life cycle of assigned Health Information Management projects by directing and coordinating the activities, evaluating workflows to ensure efficient processes and problem-solving services.

Bachelor of Science degree in Nursing/Health Information Management obtained from an accredited school of Nursing or Health Information Management; 3-5 years of clinical/coding experience in an ambulatory/professional care setting. Current State Registered Nurse License or RHIA/RHIT certification.

Knowledge of ICD-10, CPT, HCPCS Level II and III, APC, APG, pro modifiers, revenue codes, CCI edits. Proficiency in Microsoft Office Application (PowerPoint, Excel, Word, and Tableau).

Preferred Qualifications: Experience with Medicare Risk Adjustment, Hierarchical Condition Categories, coding, billing, and auditing; extensive Outpatient CDI and Risk Adjustment Coding knowledge. RN/HIM professional with current ACDIS Certified Clinical Documentation Specialist (CCDS), AHIMA Certified Documentation Practitioner (CDIP), or CCS/CPC.

Must possess good physical health. Some requirements include but are not limited to standing, sitting or walking for long periods of time. Lifting at least 10 pounds is required. Must be able to work with a moderate level of noise. Physical Effort required: Constant (67%-100%) - handling/feeling, talking, hearing, seeing Frequently (34%-66%) - NONE Occasionally (1%-33%) - lifting, carrying, pushing/pulling, balancing, stooping, crouching, reaching