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Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Manages a risk coding team responsible to develop a robust curriculum of education and training tools for Health Partners network providers to ensure coding accurately reflects the health status of patients. Works to foster an atmosphere that supports the philosophy of complete and accurate coding and documentation to assure Medicare compliance and optimal data generation. Ensures efficiency, accuracy, and compliance to CMS Policy as it relates to Coding and Documentation for the purposes of Risk Adjustment. Supports existing auditing functions by dyad partners by assisting in the development of appropriate provider queries, policy/procedures, and supports team members with the delivery of coding-focused education to providers. Assists matrix partners in working with provider populations to close Chronic Disease Gaps in Care and other defined program goals. Skilled at yielding results with a strong sense of ownership of the results.

Minimum Job Qualifications

• Licensure or other certifications: CRC (Certified Risk Coder) credential

• Educational Requirements: Bachelor's Degree

• Minimum Experience: 5+ years of related Coding/Auditing work experience. Experience supervising risk adjustment staff and deploying RA programs. 3+ years of leadership experience

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications: CPC a plus

• Preferred Educational Requirements:

• Preferred Experience:

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Knowledge of CPT, ICD-9, ICD-10, HEDIS, Medicare services and reimbursement methodologies, RBRVS.

• Extensive knowledge of Medicare and CMS Risk Adjustment payment rules, regulations, and guidelines.

• Ability to guide a matrix team to ensure accurate & complete documentation.

• Sharp communication and presentation skills, both written and verbal, with the ability to effectively communicate with people at all levels internally and externally.

• Effective time-management and project management skills, including the ability to thoughtfully plan, interpret complex processes/programs, develop realistic goals/metrics, and resolve and/or escalate issues in a timely fashion and ensure adherence to timelines.

• Solid collaboration, interpersonal, problem-solving and coaching skills.

Essential Tasks and Responsibilities

• Develops, executes, and maintains HCC comprehensive visit review program to ensure proper documentation of diagnoses and validation of diagnoses with feedback to Providers.

• Collaborates with cross-functional teams to develop relevant coding guidance to the provider population consistent with established coding authorities and in compliance with relevant federal guidance.

• Facilitates appropriate modifications to clinical documentation to accurately reflect patient severity of illness and risk through extensive interaction with Health Partners providers, care management and nursing staff, other care givers and the coding staff.

• Maintains knowledge of coding rules and program regulations to ensure the documentation in the patient record accurately reflects all elements impacting the patient risk score thereby contributing to a compliant patient record.

• Reviews data and trends, identifies additional areas of opportunity, communicates findings and recommended solutions, delivers provider-specific metrics and coaches' providers on Gap-closing opportunities as needed.

• Collaborates cross-functionally and assists with the preparation of data and reports to evaluate the effectiveness and overall impact of the clinical documentation improvement program for presentation to appropriate oversight committees.

• Educates members of the patient care team, including medical staff, on documentation guidelines on an on-going basis as needed.

• Identifies and assists in the development and implementation of departmental policies and procedures according to established workflows.

• Moves coding functions from "transactional" to "actionable" to drive accurate results.

• Coordinates with Compliance Department to establish audit processes and responses in assuring provider coding and documentation compliance with Federal and State regulatory bodies. Responds to and oversees audit requests.

• Assists with the development, implementation, and oversight of auditing projects including ensuring auditing/coding production satisfies all business needs and contractual requirements.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Moderate, Frequently 31-65% of time

• Kneeling/Stooping/Bending: Occasionally 0-30% of time

• Standing/Walking: Occasionally 0-30% of time

• Pushing/Pulling: Occasionally 0-30% of time

• Intensity of Work: Occasionally 0-30% of time

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.