Risk Analyst

Job Title

Supervises remote risk adjustment coding specialists in the PBO, support satellite operations, ensures effective follow-up and optimal processing of applications to comply with established polices procedures and time standards. Monitors, creates, and analyses applicable reports with financial and compliance data. Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness Visits, Medicare Advantage plans suspect HCC condition forms prior to submission to the payer. Educate providers on HCC coding concepts and ICD-10 coding guidelines to ensure appropriate level of coding specificity. Ensures procedures, E&M and diagnoses are coded as documented in the medical records according to ICD-10-CM, CPT-4, and HCPCS, in an effort to maintain accurate coding and obtain reimbursement, all within the professional coding guidelines, Centers for Medicare and Medicaid (CMS) guidelines and Broward Health policies.

Education

Essential: Three Years

Credentials

Essential: Certified Professional Coder