Henry Ford Health - Troy, MI
posted 26 days ago
Full-time - Senior
Hybrid - Troy, MI
Ambulatory Health Care Services
About the position
The Lead Coding and Education Specialist plays a crucial role in ensuring compliant coding and documentation by healthcare providers. This position involves leading projects focused on accurate reporting of health status for Medicare Advantage and Commercial Qualified Health Plan memberships, enhancing provider education, and improving clinical documentation and coding practices through audits and training.
Responsibilities
- Lead and oversee audits, chart reviews, and provider education for various projects.
- Become proficient in using Altegra RiskView systems for risk adjustment.
- Develop and implement project strategies to improve clinical documentation and coding compliance.
- Train and lead coding and provider education staff, providing oversight to contracted staff.
- Create educational materials and outreach strategies for providers and coders regarding risk adjustment.
- Serve as a subject matter expert on risk adjustment and medical record coding.
- Participate in multidisciplinary teams related to risk adjustment work.
- Develop annual Risk Adjustment Compliance work plan.
- Verify accuracy and appropriateness of diagnosis codes based on medical records.
- Maintain readiness for audits by creating and managing a RADV audit plan.
- Review and monitor HIPAA and CMS regulations for updates and changes.
- Target member/provider populations for risk adjustment projects using analysis and problem-solving.
- Update and manage departmental policies and procedures.
- Lead all aspects of mandatory audits related to CMS and HHS.
- Communicate audit processes and results to relevant departments and provider groups.
- Engage with the HAP provider network for outreach and education activities.
- Ensure secure medical records are maintained by operations and education teams.
Requirements
- Associates degree in Health Information Management, Health Information Technology, or related field required.
- Bachelor's degree or equivalent work experience preferred.
- Minimum of two years of experience in a coding lead or similar role.
- Minimum of five years of coding experience with proficiency in ICD-10-CM and ICD-9-CM.
- Prior experience leading teams or small groups.
- Experience with Excel spreadsheets.
- Experience working with physicians and providers' office staff.
- Knowledge of medical billing and third-party payer regulations preferred.
- Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) required; Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) preferred.
Nice-to-haves
- Knowledge of Medicare Advantage Risk Adjustment and HHS Commercial Risk Adjustment payment methodologies.
- Knowledge of CMS programs, processes, and payment principles.
- Experience working with physicians/medical groups/physician offices.
Benefits
- Health insurance
- Dental insurance
- Tuition reimbursement
