OPERATIONS AND TRANSFORMATION- RISK ADJUSTMENT CODING SPECIALIST
Location: Lewes, Delaware
Internal Number: 7151
Why Beebe? Become part of the Beebe team - an inclusive team positioned in a vibrant, coastal community. Enjoy a fulfilling career as you support the health of our patients and a team focused on excellence.
Provides thorough concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture, severity of illness, and complexity of the patient. Utilizes knowledge of official coding guidelines (ICD-10, CPT, HCPCs), Hierarchical Condition Categories (HCC), M.E.A.T (Monitored, Evaluated/Assessed/Addressed, Treated) standards, Risk Adjustment Factor (RAF) scoring, and AHIMA/ACDIS physician query brief. Provides education to providers on the importance of diagnosis specificity. May participate in developing, presenting, and disseminating provider communication and other activities related to clinical documentation.
Review provider documentation of diagnostic data from medical record to verify that all Medicare Advantage, MSSP and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum
Review 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 Hierarchical Condition Categories (HCC)
Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
Provides ongoing feedback to physicians and other providers regarding coding guidelines and requirements, including education and support for improvement in HCC coding and RAF scoring. Assists with educational in-services for physicians, other providers, and clinic staff relating to clinical documentation compliance related to billing.
Beebe Healthcare serves the Sussex County community with a medical center located in beautiful, historic Lewes, Delaware, and convenient outpatient locations throughout the county. Founded in 1916 by two physician brothers, Drs. James Beebe and Richard C. Beebe, the medical center in Lewes is a 210-licensed-bed, not-for-profit seaside community hospital. Beebe's specialized service lines include cardiac and vascular, surgical services, oncology, women's health, and orthopaedic services. Beebe offers an array of inpatient, outpatient, emergency, and diagnostic services.
Beebe's five satellite campuses offer imaging, physical rehabilitation, and lab services, as well as walk-in care centers. In addition, Beebe offers Wound Healing & Hyperbaric Medicine and Diabetes Management & Medical Nutrition Therapy.
With a mission to serve the community, Beebe also offers many free screenings and outreach programs through its Population Health Department; and advanced medical care for those who are recuperating at home through Beebe Home Care Services.
Beebe is also training the next generation of nurses through the Margaret H. Rollins School of Nursing, located behind the Medical Cente...r in Lewes.
Beebe's Medical Staff has grown tremendously since the early 1990s. Employed physicians through Beebe Medical Group and our affiliated physicians on Beebe's Medical Staff now serve patients from Milford to Millville in specialties including cardiac surgery, dermatology, endocrinology, family practice, gastroenterology, general surgery, internal medicine, pediatric neurology, and surgical oncology.
Beebe is proud to offer quality care, close to home for the residents and visitors of Sussex County.