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Summa Health · 14 hours ago

Coordinator - Coding Audit

Greater Cleveland

Full-time

Hybrid

Senior Level

$30.91/hr - $46.36/hr

5+ years exp

Summa Health is an integrated healthcare delivery system that includes hospitals and community-based health centers, providing high-quality Medicare Advantage and commercial insurance plans. The Coordinator - Coding Audit will oversee the clinical coding staff, manage chart retrieval and medical record reviews, and ensure compliance with coding practices to support risk adjustment and revenue recovery efforts.

Health CareMedicalNon Profit

Responsibilities

Organizes and coordinates staff’s time to accurately complete tasks within designated periods in fast-paced environment

Provides guidance to the clinical staff on how to be an effective team member as well as leading by example

Assigns and checks work assignments, delegates tasks, ensures quality outcomes and quantifies accomplishments associated with said tasks

Ensures staff maintains all needed coding certifications such as Certified Risk Adjustment Certification (CRC) from American Academy of Professional Coders (AAPC)

Works with clinical team to maintain current knowledge of medical coding concepts, techniques and principles in regards to risk management activities

Ensures proper compliance with regulatory agencies, oversees RADV audits and ensures data integrity thru research and issue resolution

Oversees risk adjustment initiatives, provides team oversight for process improvement and ensures compliance with all company policies and procedures

Make certain the department maintains up-to-date knowledge on risk adjustment HCC (Hierarchical Condition Categories) processing concerning ICD 9 and ICD 10 coding guidelines

Understands medical chart review processes and effectively translate the associated business needs into appropriate solutions and actions that staff can assimilate into daily work flow

Performs all the essential duties of both the coding auditors and senior coding auditors

Manages the chart review life cycle from scheduling access, collecting images, coding chart, development of the supplemental record, and submission of the RAPS file to CMS

Governs the adequacy and correctness of medical documentation as it relates to risk while actively identifying and implementing opportunities for improvement

Monitors and reports risk adjustment productivity coding levels to ensure the department achieves the desired results

Functions as a primary resource regarding quality coding per guidelines as well as supervising the quality of internal and external coders

Oversees periodic audits of revenue realization activities, implements quality oversight on the retrospective chart review process, home visits and bidirectional reviews and reports findings to the Director of Risk Adjustment as well as develops solutions and/or corrective action plans

Coordinates which associates are the liaisons with the provider community and who the official representative will be to the Health Plan Alliance Coding workshops

Supports the SummaCare Medical Directors in education and providing feedback to provider offices about medical record documentation and coding issues to facilitate accurate claims submissions and reduce the risk exposure to a RADV audit

Formulates educational materials on coding requirements and conducts training to ensure the accuracy of the medical records review process

Coordinates user group meetings, conference calls and training sessions and ensures attendance documental is supplied to Compliance

Assists in defining the parameters for chart chase logic and assists in development of all internal/external risk adjustment associated tools related to revenue enhancement or risk mitigation

Performs all job functions with integrity. Provides timely internal and external customer service in cooperatives, professional, and respectful manner

Qualification

Certified Risk Adjustment CertificationCPT codingICD 910 codingHCC codingMedical terminologyMicrosoft OfficeAttention to detailConfidentialityTeam leadership

Required

Associate degree or equivalent combination of education and/or experience

Certified Risk Adjustment Certification (CRC) or Certified Professional Coder (CPC) from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) equivalent

Five (5) years of experience that has provided leadership skills to include, delegating tasks, overseeing medical chart reviews, and/or risk adjustment processes which has provided along with an in-depth working knowledge of CPT coding, ICD 9 and 10 coding, medical terminology, and solid working knowledge of HCC coding

Demonstrate strong attention to detail and understanding the medical record in order to determine the appropriate health conditions (correct diagnosis codes) that should be submitted as additions or redactions for risk adjustment

Ability to maintain confidentiality of patient and business information

Demonstrate knowledge of Microsoft Office suite and other software for electronic processing of medical records

Flexible: ability to adjust work hours to meet business demands

Sit for prolonged periods

Bend, stoop, and stretch

Lift up to 20 pounds

Manual dexterity to operate computer, phone, and standard office machines