Risk Adjustment Analyst - Mount Sinai Health Partners

Mount Sinai Morningside; New York (NY); On-site; USD 65,000 - 99,000; Full time

Job summary

Une opportunité passionnante s'offre à un Analyste en Ajustement des Risques au sein de l'équipe de Mount Sinai. Ce rôle clé vise à améliorer la qualité des dossiers médicaux dans un cadre ambulatoire et nécessite une solide expérience en codage HCC. Le candidat idéal collaborera étroitement avec les médecins et les responsables de la documentation clinique pour garantir la conformité et l'exactitude des enregistrements. Rejoignez-nous pour contribuer à l'excellence des soins de santé.

Qualifications

• Minimum de 3 ans d'expérience en codage.
• Connaissance approfondie de l'ICD-10-CM et des exigences de validation des données HCC.
• Certificat de codeur en ajustement des risques (CRC) requis.

Responsibilities

• Supporter les efforts d'amélioration de la documentation clinique.
• Effectuer des audits de dossiers médicaux pour assurer la précision des codes.
• Identifier les besoins en formation lors des examens des dossiers.

Skills

Communication

Time Management

Organization

Education

High school diploma or GED

Tools

Microsoft Excel

Microsoft Access

Job description

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Description

Job Description

MSHP seeks a Risk Adjustment Analyst support efforts to improve the overall quality and completeness of clinical documentation in outpatient physician practices. He/ She will work closely with physicians, Health Information Management and the Mount Sinai Health Partners team to review and code ambulatory medical records, identify opportunities to improve coding, educate physicians, and act as a liaison between all parties.

Responsibilities

• Focuses on Risk Adjustment HCC Coding and Documentation via pre-visit queries to PCPs and specialists.
• Utilizes AI and NLP tools via EHR to assist in presenting valid and active HCC opportunities to clinicians prior to patient visits.
• Performs audits of medical charts to ensure all appended ICD-10-CM codes are accurately supported by written clinical documentation.
• Reviews charts to assess the clinical status of patients, current treatment plan, and past medical history to identify potential gaps in clinical documentation related to outpatient encounters, with a particular focus on primary care visits and some specialist visits.
• Analyzes data post patient visit and follows up with clinicians if any documentation or coding deficiencies are found in the visit notes or patient medical record.
• Uses clinical skills to review clinical opportunities for clinicians to assess, plan, monitor conditions prior to patient visits.
• Facilitates improvement in the overall risk adjustment quality, completeness and accuracy of medical record documentation.
• Updates claims prior to claim submission as needed to ensure they accurately reflect the clinical status of patients and the type of care delivered.
• Participates in data acquisition, development of performance reports and communication of results to physicians, practice managers, and the Risk Adjustment Clinical Documentation leadership team.
• Interacts regularly with physicians, NPs, and PAs.
• Monitors CMS and OIG websites and abides by ICD-10-CM Coding Guidelines and AHA Coding Clinics as needed.
• Identifies training needs identified during chart review and acts as clinician and department leadership liaison.
• Identifies opportunities to promote quality in Value Based Care-related work.
• Performs other related duties.
  
  

Qualifications

Education Requirements

• High school diploma or general education degree (GED); or equivalent
  
  

Experience Requirements

• Minimum of 3 years coding experience
• At least 2 years of HCC Risk Adjustment experience, preferred
• Clinical background in a healthcare setting, preferred
• Demonstrated experience with front and back-end process improvement initiatives in a professional healthcare setting
• Thorough knowledge ofICD-10-CM and CPT coding books
• Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements
• Experience with Microsoft Excel and Access
• Strong communication and mentoring skills
• Ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization, including clinicians and practice management
• Strong time management skills
• Excellent organization skills
• Must possess high degree of accuracy, efficiency and dependability
• Excellent written and oral communication for representation of clear and concise results
  
  

Licensing And Certification Requirements (if Applicable)

• Certified Risk Adjustment Coder (CRC) credential required
• Credentials in one or more of the following, preferred:
• Certified Professional Medical Auditor (CPMA)
• Certified Documentation Integrity Practitioner (CDIP)
• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)
  
  

Compensation Statement

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $65,885.00 - $98,827.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

, E01 - Partner MSO Services - MSH, Mount Sinai Hospital

Employer Description

Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About The Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Compensation

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $65885 - $98827 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Hospitals and Health Care

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