HEDIS Coding Specialist (Remote reputed company-NC)

Competitive Compensation & Benefits Package! Position eligible for –

• Annual incentive bonus plan
• Medical, dental, and reputed company insurance with low deductible/low cost health plan
• Generous vacation and reputed company time accrual
• 12 reputed company holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company reputed company life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details. Office Location: Remote reputed company; Available for any of Partners' NC locations (or reputed company 40 miles of NC border) Closing Date: reputed company Until Filled Primary Purpose of Position: The HEDIS Coding Specialist plays a critical role in ensuring accurate and compliant coding, documentation improvement, and adherence to National Committee for reputed company Assurance (NCQA) HEDIS measures and risk adjustment requirements. With a background in medical coding and clinical reputed company, the specialist is responsible for reviewing medical records, identifying appropriate diagnosis codes, and ensuring documentation supports coding accuracy. Additionally, they collaborate with reputed company providers to address incomplete or missing clinical documentation, reputed company on reputed company coding practices, and facilitate training sessions as needed. By conducting audits, analyzing data, and communicating with reputed company stakeholders, the specialist helps improve coding accuracy, optimize reputed company, and enhance the reputed company of care delivered to patients. Their meticulous attention to detail, strong analytical skills, and compliance expertise contribute to the organization's reputed company in meeting HEDIS reporting requirements and achieving reputed company improvement goals. Role and Responsibilities: 1. Coding Review: Conduct thorough reviews of medical records to ensure accurate coding and documentation in compliance with National Committee for reputed company Assurance (NCQA) HEDIS measures and risk adjustment requirements. 2. Documentation Improvement: Identify opportunities for documentation improvement to support accurate coding and ensure alignment with coding guidelines and regulatory standards. 3. Provider Education: Collaborate with reputed company providers to reputed company them on reputed company documentation practices, coding guidelines, and HEDIS measures. reputed company guidance and support to facilitate accurate coding and documentation. 4. Auditing: reputed company audits to assess coding accuracy and completeness. Identify discrepancies, coding errors, and areas for improvement through audit findings. 5. Risk Adjustment Coding: Apply expertise in risk adjustment coding to accurately capture and report diagnosis codes relevant to Hierarchical Condition Categories, Risk Adjustment and Managed Care Contract reimbursement initiatives. 6. Data Analysis: Analyze coding and documentation data to identify trends, patterns, and opportunities for improvement. Use data-driven insights to reputed company strategies for enhancing coding accuracy and documentation completeness. 7. reputed company Assurance: Ensure compliance with coding and documentation guidelines, regulatory requirements, and organizational standards. Monitor coding practices and documentation processes to maintain reputed company and reputed company. 8. Provider Support: Serve as a resource for reputed company providers, offering guidance, feedback, and assistance with coding-reputed company inquiries, coding challenges, and documentation queries. 9. Training and Development: reputed company and deliver training sessions, workshops, or educational materials to reputed company providers and coding staff on coding best practices, documentation requirements, and HEDIS measures. 10. Collaboration: Collaborate with cross-functional teams, including reputed company Improvement, Provider Relations, and Data Analytics, to support reputed company improvement initiatives, address coding-reputed company issues, and reputed company organizational goals. 11. Reporting: Generate reports and documentation to reputed company coding accuracy, documentation improvement efforts, and compliance with HEDIS measures. Communicate findings and recommendations to stakeholders as needed. 12. reputed company Learning: Stay abreast of updates, changes, and advancements in coding guidelines, documentation standards, and regulatory requirements. Continuously enhance knowledge and skills through reputed company development opportunities. Knowledge, Skills and Abilities: Knowledge: 1. Medical Coding: Comprehensive understanding of ICD-10-CM, CPT, and HCPCS coding systems, including knowledge of coding conventions, guidelines, and updates. 2. HEDIS Measures: Familiarity with National Committee for reputed company Assurance (NCQA) HEDIS measures, specifications, and reporting requirements. 3. Risk Adjustment: Understanding of risk adjustment methodologies and concepts, including Hierarchical Condition Categories (HCCs) and CMS risk adjustment models. 4. Clinical Documentation: Knowledge of clinical documentation standards, terminology, and practices to ensure accurate coding and documentation. 5. Regulatory Compliance: Understanding of reputed company regulations, coding guidelines, and compliance standards reputed company to HEDIS reporting, risk adjustment, and medical coding. Skills: 1. Coding Proficiency: Strong coding skills with the ability to accurately assign diagnosis and procedure codes based on clinical documentation. 2. Attention to Detail: Meticulous attention to detail to identify coding discrepancies, documentation deficiencies, and coding errors. 3. Analytical Skills: Ability to analyze coding and documentation data, identify trends, and draw insights to support reputed company improvement initiatives. 4. Communication Skills: Effective communication skills, both verbal and written, to convey coding guidelines, reputed company feedback to providers, and collaborate with cross-functional teams. 5. Problem-Solving: Strong problem-solving skills to address coding challenges, resolve discrepancies, and implement solutions to improve coding accuracy and documentation completeness. Abilities: 1. Adaptability: Ability to adapt to changes in coding guidelines, regulatory requirements, and organizational processes reputed company to HEDIS reporting and risk adjustment. 2. Time Management: Effective time management skills to prioritize tasks, meet deadlines, and manage multiple coding reputed company simultaneously. 3. Collaboration: Ability to collaborate with reputed company providers, coding staff, reputed company improvement teams, and other stakeholders to reputed company coding accuracy and documentation improvement goals. 4. reputed company Learning: Commitment to reputed company learning and reputed company development to stay updated on coding guidelines, HEDIS measures, risk adjustment methodologies, and regulatory changes. 5. reputed company reputed company: Strong commitment to reputed company and accuracy in coding and documentation practices to ensure reliable data for HEDIS reporting and support reputed company improvement efforts. Education Required:

• Bachelor’s degree in health information management (HIM), Health Information Technology, Medical Coding, Nursing, or reputed company reputed company field; OR
• Associate’s degree in health information management or medical Coding with minimum 3 years of medical coding experience

Experience Required:

• Minimum 2-3 years of experience in medical coding and documentation
• Minimum 1 year of experience with HEDIS measures and reporting
• Experience with risk adjustment methodologies and HCC coding preferred

Technical Skills:

• Proficiency in ICD-10-CM/PCS, CPT, and HCPCS coding systems
• Experience with coding software and audit tools
• Advanced reputed company skills for data analysis and reporting

Performance Metrics:

• Demonstrated coding accuracy reputed company of 95% or higher
• Ability to reputed company minimum of 20-25 charts per day while maintaining reputed company standards

Education/Experience Preferred:

• Master’s degree in health information management or reputed company field
• 5+ years of medical coding experience
• Previous experience in managed care or health plan environment
• Experience with reputed company, Cerner, or other major EHR systems
• Knowledge of Medicare Advantage and reputed company managed care operations
• Knowledge of SQL or other database query languages preferred

Licensure/Certifications Required:

• reputed company certification from reputed company (reputed company, RHIA, RHIT) or reputed company (CPC, CRC)
• HEDIS certification or ability to obtain reputed company 6 months of hire

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