Coder Analyst
Location: Detroit Michigan
Description: netPolarity is looking of Coder Analyst right now, this occupation will be placed in Michigan. For complete informations about this occupation opportunity please read the description below. Job Description:
Scope of work: RMRA/Stars INITIATIVE
This project will involve training, education, review of records to encompass a variety of initiatives. The nurses and coders will be exp! ected to participate in provider and hospital visits to educate, train and review medical records to determine
- Appropriateness of documentation for select conditions
- Proper coding of the patient¿s condition
- Physician signature requirements are met (CMS guidelines)
- Patient identification documented in the medical records.
- Verify and help providers close treatment opportunities (HEDIS/Stars measures)
- Assist and train providers on how to close diagnoses gaps
- Train providers on the use of HEB
- Perform clinical reviews with knowledge of body systems, anatomy and physiology.
- In addition, contractors will
- Assist other departments, consultants when visiting providers to discuss a variety of HEDIS/Stars
- Conduct other activities as assigned which may include other initiatives beside RMRA and Sta! rs
- Scan records as required
- Generate summary! of activity as requested
- Develop and maintain an effective professional working relationship with providers.
- Contact or answer questions (educate) for instate and outstate providers
- Other duties may be assigned.
- Certified professional coders with at least two years coding experience
- R.N. licensed in Michigan; BSN degree preferred; minimum Associate degree acceptable with a minimum 5 years professional experience, (preferably with at least 2 years in adult medicine or community health)
- Proficient in PC and MS Office skills, particularly Word and Excel
- Effective communication skills, written and verbal
- Working knowledge of CMS requirements
- Audit and medical chart review experience preferred
- Excellent interpersonal skills necessary to interact with all levels of personnel
- Working knowledge of HEDIS measures and NCQA requirements a plus !
- Valid MI drivers license; willing to drive to provider locations
- Have a dependable vehicle every work day ¿ be willing to travel five days a week
- Be willing to commit to an assignment potentially lasting through 2014
The contractors will be reviewing medical records to help providers improve their documentation and coding. They will be educating, training and providing assistance in a variety of ways to help providers close gaps in diagnoses and treatment opportunities.
The overarching goal for Medicare Advantage is to improve the RADV scores and STAR ratings to improve CMS reimbursment. Improving coding for all products is needed for our commercial business to appropriately risk adjust the small groups and IBU to comply with the health insurance exchange beginning on 1/1/2014.
The provider education component has the potential to impact health care delivery to members across all lines of business; t! herefore, it is expected to positively impact clinical outcomes.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to netPolarity.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Wed, 24 Jul 2013 20:51:50 GMT