Risk Adjustment Analyst- HIM OP CDI

UNC Health Care; Chapel Hill (NC); Remote; USD 80,000 - 100,000; Full time

Job summary

Join a forward-thinking organization dedicated to improving community health. As a Risk Adjustment Coordinator, you will analyze medical records and collaborate with insurance companies to ensure accurate coding and documentation. This role emphasizes professional development and offers a supportive environment to enhance your skills in a vital healthcare sector. With a focus on quality and compliance, you'll play a crucial part in maintaining high standards of patient care while working remotely. If you're passionate about healthcare and eager to contribute to a meaningful mission, this opportunity is perfect for you.

Qualifications

• Minimum 12 months in outpatient coding or nursing in ambulatory care.
• Successful completion of OP CDI Proficiency Test required.

Responsibilities

• Perform payer audits validating providers and responding to requests.
• Review cases in HCC Edit WQ for claim submission diagnoses.
• Create educational materials for providers and staff.

Skills

Medical Documentation

Coding Knowledge

Communication Skills

Organizational Skills

Critical Thinking

Sound Judgment

Education

High School Diploma or GED

Tools

EPIC WQ

PCIC Dashboards

Spreadsheets

Job description

Job Description

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the communities we serve.

Summary:

The Risk Adjustment Coordinator analyzes and audits medical records retrospectively as requested by insurance companies under the value care contracts. They work with the EPIC WQ to reorder the Hierarchical Condition Categories (HCC) conditions in the top 12 for claim generation. The coordinator also completes Pre-Visit Planning reviews daily to enhance HCC capture and persistency.

Responsibilities:

1. Perform payer audits as required under the Value Care contracts, validating providers and responding to payer requests.
2. Review cases in the HCC Edit WQ to identify diagnoses needing reordering before claim submission.
3. Create and update educational materials for providers and staff, such as HCC/RAF Pocket Guides and coding tip sheets.
4. Conduct pre-visit medical record reviews to identify conditions from the past two years that require updating for the current year, ensuring HCC persistency.
5. Use compliant query processes to facilitate accurate clinical documentation and collaborate with staff to resolve queries.
6. Utilize systems like PCIC dashboards, reports, and spreadsheets for data collection and reporting KPIs.
7. Engage in ongoing professional development to stay current with documentation, coding, and quality standards.

Other Information:

Education: High school diploma or GED; successful completion of the OP CDI Proficiency Test.

Licensure/Certifications: Must hold one of the following: AHIMA, AAPC, CPC, CRC, ACDIS, RN, LPN, NP, PA, or MD license.

Experience: Minimum of 12 months in outpatient coding or nursing in ambulatory care.

Skills and Abilities: Strong knowledge of medical documentation and coding, clinical knowledge, excellent communication, organizational skills, critical thinking, and sound judgment.

Job Details:

Legal Employer: NCHEALTH

Entity: Shared Services

Unit: HIM OP CDI

Type: Full Time

Hours: 40/week

Salary Range: $24.73 - $35.56/hour, based on experience and internal equity

Work Arrangement: Remote

Schedule: Day Job

Location: Chapel Hill, NC

Overtime: Exempt

This position is employed by NC Health, part of UNC Health Care System. Qualified applicants are considered regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Reasonable accommodations are provided upon request.