Clinical Quality Management Analyst

Are you an experienced Clinical Quality Management Analyst with a desire to excel? If so, then Talent Software Services may have a job for you! Our client is seeking an experienced Clinical Quality Management Analyst to work at their company 100% remotely.

Position Summary: This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs (MA and ACA), using skills including but not limited to: HCC Coding, medical coding, clinical terminology and anatomy/physiology, CMS coding guidelines, and RADV Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all RPM risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.

Primary Responsibilities/Accountabilities:

• Perform HCC coding on projects for MA, ACA, and ESRD. Ability to quickly flex between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models.
• Ability to work independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and Company's Policy and Procedures to guide HCC coding decision making.
• Maintains RPM coding accuracy and productivity requirements.
• Assist with Regulatory Audits by performing first coding review and ranking of charts.
• Build partnerships and work within coding teams and internal partners critical to HCC coding.
• Participate on ad-hoc projects per the direction of Leadership to address the needs of the department.
• Provide recommendations for process improvements and efficiencies.
• Fully engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Qualifications:

• Associate degree or 3 years of relevant work experience with Coding and/or Healthcare
• 3+ years in HCC Coding and/or Healthcare
• Must have one of the following certifications: CRC, CPC, CCS, RHIT

Preferred:

• Bachelor's degree
• 5 years in HCC Coding and/or Healthcare