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Job Summary

Provides training and process improvement efforts across the clinical practices for the development of consistent and comprehensive clinical practices supported by the the Health Plan. Identifies process improvement opportunities associated with the management of risk adjustment initiatives. Investigates current processes, assessing efficiency and accuracy and provides solutions for problems, process improvement, development of training programs, and documentation strategies that support ICD-10 complex terminology for clinical practice operations and management. Serves as a liaison between Clinical Operations and the Risk and Revenue Management team, and facilitates communication between various constituents in order to assist in capturing chronic disease burden of the clinical enterprise patient population.

Job Duties

• Reviews the content of the medical record professional outpatient records to identify all diagnosis codes applicable to the documentation.

• Carefully reviews details of documents such as laboratory findings, radiology reports, various scanned reports, discharge summaries, history and physical, consultations, orders, progress notes and other ancillary services treatment records needed to ensure all pertinent diagnoses are recorded.

• Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form using proper procedure codes as required.

• Using the Encoder software program, determines the codes for all diagnoses.

• Reviews and understands annual mapping of ICD-9 and ICD-10 crosswalk.

• Provides education material to the team to educate physicians as needed to clarify documentation within the patient’s record to facilitate complete and accurate coding.

• Assists in decision making relevant to physician coding education and HCC targeting purposes.

• Works one-on-one with physicians as needed to verify that documentation within the patient’s record is appropriate in order to facilitate accurate and complete coding.

• Assumes a supporting co-educating role with regard to Risk Adjustment Education and other opportunities for internal education team and external identified opportunities.

• Presents with full understanding of reports, presentations, maps and graphs, reflecting the collaboration of external and internal parties, summary and translation of data into actionable information.

• Works with provider sites to define solutions to needs or problem areas, and determines scope of investigation required to obtain solution.

• Interprets and recommends actionable plans using financial and analytical data prepared by risk adjustment analysts.

• Provides consultative support to clinical areas on a daily basis and recommends operational strategies to achieve optimal documentation and coding processes.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and/or completed specialty training program (1 year of specialty training = 1 year relevant experience).

If a suitably experienced candidate cannot be found, applicants who meet the basic qualifications but possess fewer years of experience will be considered for hire at a lower level. Salary would commensurate with experience.

Position Details

Level II - Minimum 1 certification requiredRHIT

CPC

CRC

CCS

Internet requirements:

​ Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:

• •25 MBPS UP

• •75 Mbps DOWN

• •<150 ms Ping Required

• •<30ms Jitter Required

  Computer must be connected to the internet via Ethernet cable; wifi is not permitted unless a Virtual Private Network (VPN) is used for the wifi connection

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 3 years-Relevant experience* (Required)

Certification(s) and License(s)

Certified Professional Coder - American Academy of Professional Coders (AAPC); Certified Coding Specialist - American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) - American Health Information Management Association; Certified Risk Adjustment Coder - American Academy of Professional Coders (AAPC)

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.