Prospect Medical Systems · 7 hours ago
HCC Risk Adjustment Specialist
Orange, CA
Full-time
Remote
Entry, Mid Level
2+ years exp
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Responsibilities
Abstract pertinent information from assigned medical records using ICD-9-CM, CPT and/or HCPCS codes.
Provide management with input on provider performance from assigned audits and special projects
Document detailed chart audit findings including documentation errors; medical record errors; diagnosis errors as well as missed HCC opportunities in applicable audit tools on a daily basis
Ensure audit tools contain adequate evidence to support audit findings and reviews audit tools for accuracy and completeness.
Ensure all captured diagnoses is properly documented and supported within progress note according to CMS rules and regulations including but not limited to encounter date, legibility, proper provider signature and member identification requirements.
Report noncompliance issues detected through auditing.
Work with Medical Management to provide confidential feedback on special audits on as needed basis
Adheres to Official Coding Guidelines.
Research and provide courteous, accurate and timely response to inquires by providers as related to HCC Risk Adjustment projects and reports.
Assist with reconciliation of invalid diagnosis list supplied by Other Departments
Serve as a resource for internal and external customers to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements
Work with Health plans to ensure appropriate status information for member is reflected
Provide one on one provider training and audit sessions as requested by management
Attendance of additional provider training sessions based on departmental needs
Assist with chart retrieval from provider office based on departmental needs. This may include some travel with personal vehicle
Perform various audits and special projects as assigned by management
Qualification
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Required
A High School Diploma or Equivalent
Two to five (2 - 5) years experience in healthcare setting preferably related to HCC Risk Adjustment and/or chart auditing
Must possess and maintain an AAPC or AHIMA certification — CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, RHIA
Preferred
BS/BA
Company
Prospect Medical Systems
With approximately 9,000 physicians to serve our 660,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Arizona, Texas, and Rhode Island.
501-1,000 employees
Funding
Current Stage
Late StageLeadership Team
Jim Brown, MBA, MPH
Chief Executive Officer
L
Lily Kam
Chief Financial Officer
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