Value Based Coder Job ID 2018-64228 Employment Type Full Time Department Clinical Integration Hours / Pay Period 80 Facility Dignity Health Management Services Organization Shift Day Location Phoenix State/Province AZ Standard Hours Monday - Friday 8:00 AM - 5:00 PM Work Schedule 8 Hour Overview The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Healths Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. Responsibilities Arizona Care Network (ACN) is a clinically integrated physician network and is a Dignity Health and Abrazo Health (Tenet) physician collaboration. The Value Based Coder is an employee of Inland Health Organization of Southern California, Inc., doing business as Dignity Health Managed Services Organization, a physician support organization owned by Dignity Health. As a member of the Clinical Performance team, the Value Based Coder works with providers and office staff across the network to identify opportunities for improved quality, risk adjustment coding performance. The Value Based Coder is a valuable resource in process improvement and identifying clinically appropriate risk adjusting conditions to capture. PRINCIPLES DUTIES AND RESPONSIBILITIES Review patient medical record information on both a retroactive and prospective basis to identify, assess, monitor and document claims and encounter coding information as it pertains to risk adjustment Ensure that the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe Assess adequacy of documentation of claims and query outpatient provider claims to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding Audit provider documentation ICD-10 codes to ensure adherence with CMS Risk Adjustment guideline Participate network performance improvement initiatives. Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security. Performs other duties as assigned. Qualifications A) EXPERIENCE: 2-3 years of experience in outpatient coding preferred. Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements. Computer literacy of medical information system, records management software, encoders. Advanced knowledge of CPT and ICD-10 coding required. Knowledge of federal and state guidelines on all coding systems and sponsored programs B) EDUCATION AND TRAINING: Associate degree in healthcare or equivalent work experience. C) LICENSE, CERTIFICATION: Certified Professional Coder (CPC) or Certified Risk Coder (CRC). D) OTHER REQUIREMENTS: Must have excellent verbal communication skills. Proficiency in MS office (outlook, excel, word).