What are the responsibilities and job description for the Clinical Quality Management Analyst position at TALENT Software Services?
CLINICAL QUALITY MANAGEMENT ANALYST
Job Summary: Talent Software Services is in search of a Clinical Quality Management Analyst for a contract to hire position which can be worked 100% remotely.
Position Summary: This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs (MA and ACA), using skills including but not limited to: HCC Coding, medical coding, clinical terminology and anatomy/physiology, CMS coding guidelines, and RADV Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all RPM risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.
Primary Responsibilities/Accountabilities:
Providing consulting opportunities to talented people since 1987, we offer a host of opportunities including contract, contract to hire and permanent placement. Let's talk!
Job Summary: Talent Software Services is in search of a Clinical Quality Management Analyst for a contract to hire position which can be worked 100% remotely.
Position Summary: This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs (MA and ACA), using skills including but not limited to: HCC Coding, medical coding, clinical terminology and anatomy/physiology, CMS coding guidelines, and RADV Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all RPM risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.
Primary Responsibilities/Accountabilities:
- Perform HCC coding on projects for MA, ACA, and ESRD. Ability to quickly flex between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models.
- Ability to work independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and Company's Policy and Procedures to guide HCC coding decision making.
- Maintains RPM coding accuracy and productivity requirements.
- Assist with Regulatory Audits by performing first coding review and ranking of charts.
- Build partnerships and work within coding teams and internal partners critical to HCC coding.
- Participate on ad-hoc projects per the direction of Leadership to address the needs of the department.
- Provide recommendations for process improvements and efficiencies.
- Fully engages in RPM Coding educational meetings and annual coding Summit.
- Other duties as assigned.
- Associate degree or 3 years of relevant work experience with Coding and/or Healthcare
- 3 years in HCC Coding and/or Healthcare
- Must have one of the following certifications: CRC, CPC, CCS, RHIT
- Bachelor's degree
- 5 years in HCC Coding and/or Healthcare
Providing consulting opportunities to talented people since 1987, we offer a host of opportunities including contract, contract to hire and permanent placement. Let's talk!
