Hcc Coding Specialist

Overview

As an integral member of the Covenant Health Care Partners team, the HCC Coding Specialist shared accountability for ensuring the providers of CHP are documenting and coding conditions in accordance to the CHP standard. This role will assist the HCC Coding Auditor Educator with provider education and subsequently improve documentation across HCC coding, providing increased revenue to help meet our mission of providing extraordinary care to every generation.

The HCC Coding Specialist will review performance metrics and reports, as well as patient charts, to identify areas of opportunity to support effective documentation practices, coding accuracy, and coding persistency. This position will assist in educating all primary and specialty care providers and other clinical staff on processes for improving coding accuracy performance, proper documentation, and improved HCC performance in coding specificity and persistency to fully capture the risk of our population.

HCC Coding Specialist demonstrates excellent customer service performance in attitude and actions that are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant Healthcare and the commitment to Extraordinary Care for Every Generation.

• Compile payer data as well as Epic data related to risk coding and documentation performance.
• Adhere to coding rules for coding professional to ensure quality coding based upon documentation within the patient record.
• Follow policies, procedures and guidelines to assure consistent coding quality. At the same time utilize analytical skills when reviewing charts, interpreting documentation and applying codes, sufficient edits, etc.
• Assist in the identification of opportunities to improve coding accuracy through chart review and report review.
• Review charts and query providers to address documentation reassessment opportunities to prompt higher accuracy and/or specificity.
• Identify pre‑ and post‑encounter opportunities for HCC Coding Auditor Educator and assist as needed in physician meetings.
• Special projects as assigned for HCC analytics.
• Assist in preparing presentations and materials for coding performance and opportunities to CHP leadership and the general physician membership at Medical Management Group meetings.
• Participate in the work of the risk adjustment team.
• Participate in process improvement activities and assist in the creation of coding support tools for CHP physicians.
• Demonstrate ability to appropriately use coding principles that comply with CMS regulations and CHP/Covenant goals and policies.
• Ensure compliance with established coding guidelines, third‑party reimbursement policies, regulations, and accreditation guidelines.
• Work with all payers to meet audit/documentation requirements.
• Assist in providing direct and timely response to compliance audit plan results.
• Formulate and use effective working relationships with all members of the department, physicians, external customers, patients and other staff members of departments encountered.
• Participate in department meetings and area‑specific meetings (Professional coding, Practice Managers, billing, routine specialty, clinical areas, resident/physician meetings, etc.) as required.
• Independent learning with desire for continued personal and professional growth. Stay current on coding updates and publications.
• Utilize numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed.
• Maintain professional credentials.
• Perform other duties as assigned.

• Associate’s degree required, bachelor’s degree preferred.
• Professional coding certification (CPC, CRC) required. Candidate may substitute two (2) years ICD‑9/10CM and CPT‑4 coding experience with understanding that the Certified Professional Coder (CPC) requirement be fulfilled within 12 months of hire.
• Experience in professional coding setting/physician office setting preferred.

• Familiarity with electronic health records (preferably Epic, Intelicode, Systoc, AAPC, etc.) documentation methodologies.
• Knowledge/understanding of medical terminology and…