Coding Quality Analyst - Remote

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This physician led, patient centric, and data driven business creates value by delivering and facilitating care across the full continuum through high performing networks comprised of owned, managed and contracted physicians, advanced practitioners and other providers. Our system impact extends across physicians, specialty care, urgent care, home health, post-acute transitions, complex care in skilled nursing facilities and palliative care.

This position is responsible for prospective and retrospective review of the Electronic Health Record (EHR) to assist providers in more specific and complete documentation and coding. Through interaction with the physicians and other clinicians, this role facilitates improvement in the quality, completeness, and accuracy of the medical record documentation to support severity of illness, medical necessity, risk adjustment factor and level of services rendered.

• Conducts concurrent reviews of selected patient records to address clarity, completeness, consistency, and precision of clinical documentation
• Demonstrates understanding of clinical documentation requirements to ensure that the severity of illness, risk of mortality, and services provided are accurately reflected in the record
• Serves as a resource on appropriate clinical documentation to support the coded conditions and risk adjustment factors
• Communicates documentation discrepancies and coding definitions to the physicians both written and verbally as needed to clarify clinical documentation in accordance to query standards and/or policies
• Conduct 1:1 educational session with physicians and other healthcare team members related to specific documentation and coding requirements
• Collaborates and educates he multi-disciplinary team, including physicians, nurse practitioners, physician assistants, executive directors, practice managers, coding/billing staff and others regarding clinical documentation and coding best practices
• Utilizes the electronic health record effectively
• Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints
• Participates in quality and performance improvement activities
• Attends meetings and participates on committees as requested
• Reviews current literature and attends training sessions and seminars to keep informed of new developments in the field and to maintain certification
• Performs other related duties and responsibilities as directed

• Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) or RHIT
• Coding experience in physician-based settings (physician offices or group practices) or in the payer environment

• Certified Risk Adjustment Coder (CRC)
• Knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses
• Sound knowledge of medical coding guidelines and regulations
• Expert knowledge in health information documentation, data integrity, and quality
• Expertise in reviewing and assigning accurate medical codes for diagnoses performed by physicians and other qualified healthcare providers in the office setting
• Expert in ICD-10 diagnosis coding
• Keen understanding of the impact of diagnosis coding on risk adjustment payment models
• Understand the use of data mining from data captured through risk adjustment coding
• Understand predictive modeling from data captured through risk adjustment coding
• Proven ability to apply proper diagnosis code assignment under various risk adjustment models including HCC, CDPS, ACA-HHS and private payer models
• Proven ability to identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding
• Reside in Kansas City KS or Kansas City MO