Risk Adjustment Analyst- HIM OP CDI

Acord (association For Cooperative Operations Research And Development); Chapel Hill (NC); Remote; USD 80,000 - 100,000; Full time

Job summary

Join a forward-thinking organization dedicated to enhancing community health and well-being. As a Risk Adjustment Coordinator, you will play a crucial role in analyzing medical records and ensuring accurate coding for insurance claims. This position offers the opportunity to work remotely while collaborating with clinical teams to improve documentation practices. You will engage in continuous professional development, staying updated on coding guidelines and quality measures. If you are passionate about making a difference in healthcare and possess strong analytical and communication skills, this role is perfect for you.

Qualifications

• 12 months of outpatient coding or nursing experience in an ambulatory setting.
• Successful completion of the OP CDI Proficiency Test.

Responsibilities

• Perform payer audits and validate provider data.
• Conduct pre-visit medical record reviews to ensure documentation accuracy.
• Assist in creating educational materials for providers and staff.

Skills

Medical Documentation

Coding Guidelines

Critical Thinking

Organizational Skills

Communication Skills

Education

High School Diploma or GED

Tools

PCIC Dashboard

Spreadsheets

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 is responsible for analyzing and auditing medical records retrospectively as requested by insurance companies under third-party payer contracts. This role involves working with the EPIC WQ to reorder the Hierarchical Condition Categories (HCC) for claim generation and completing Pre-Visit Planning reviews to enhance HCC capture and persistency.

Responsibilities:

1. Perform payer audits required under Value Care contracts by validating provider data and responding to payer inquiries.
2. Review cases in the HCC Edit WQ to determine which diagnoses need reordering before claim submission.
3. Assist in creating and updating 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 that require updating for the current year, ensuring HCC conditions are documented annually to support clinical documentation and severity of illness.
5. Use compliant query processes and collaborate with clinical and non-clinical staff to resolve documentation queries.
6. Utilize software tools like the PCIC dashboard, reports, and spreadsheets for accurate data collection and reporting of KPI metrics.
7. Engage in ongoing professional development to stay current with documentation, coding guidelines, and quality measures.

Other Information:

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

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

Professional Experience Requirements: Minimum of 12 months of outpatient coding or nursing experience in an ambulatory setting.

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

Job Details:

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: HIM OP CDI

Work Type: Full Time

Standard Hours: 40/week

Salary Range: $24.73 - $35.56/hour (Hiring Range)

Work Assignment: Remote

Schedule: Day Job

Location: Chapel Hill, NC

Exempt from Overtime: No

This position is employed by NC Health, a subsidiary of UNC Health Care System, providing shared services across UNC Health. Applicants will be considered regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. Reasonable accommodations are available; contact [e-mail] for assistance.