Job Description:

• Provide clinically based prospective, concurrent, and retrospective reviews of medical records for WellSense of members enrolled in value-based agreements
• Review risk adjustment gap lists for members, including suspect conditions
• Perform chart reviews to determine clinical validity of open gaps
• Utilize Physician documentation queries to communicate clinical indicators to Physicians/Other Qualified Health Care Providers
• Facilitate appropriate physician documentation of care delivery to accurately reflect patient severity of illness and risk of mortality
• Track and Trend CDI findings and provider engagement for clinical documentation education purposes for any specialty within the hospital system

Requirements:

• Bachelor’s degree in Nursing or Health Information Management is required
• Minimum 5 years related experience working on the payer or provider side in Risk Adjustment Validation including prospective documentation reviews and pre-visit planning
• Certified Risk Adjustment Coder required
• Population Health experience, NCQA/HEDIS CDS experience preferred
• Knowledge of care delivery documentation systems and related medical record documents
• Excellent understanding of ICD10CM coding and guidelines
• Ability to work independently in a time-oriented environment
• Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes

Benefits:

• Health insurance
• Discretionary annual bonuses
• Merit increases
• Flexible Spending Accounts
• 403(b) savings matches
• Paid time off
• Career advancement opportunities
• Resources to support employee and family well-being