Job Description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Conducts prospective review to abstract Hierarchical Condition Categories (HCC's) codes to report for the calendar year. Communicates (via Epic and in person) with providers on any outstanding HCC capture opportunities. Conducts retrospective reviews to ensure that documentation supports reporting the Hierarchical Condition Category code prior to payor submission.

Essential Functions

All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Conducts prospective review of charts to identify HCC opportunity. Conducts retrospective review of charts to confirm documentation supports reporting. Utilizes payor specific software to assist in capturing HCCs. Communicates with providers about HCC opportunities for improvement. Identifies suspect conditions that would potentially support reporting an HCC. Participates in education offerings Participates in monthly meetings Performs other duties as assigned.

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

Education - High School diploma or equivalent or post-high school diploma / highest degree earned. Associate degree preferred Experience - Five (5) years professional fee coding experience

In Lieu Of

NA

Required Certifications, Registrations, Licenses

Certified Professional Coder (CPC), and Certified Risk Adjustment Coder (CRC)

Knowledge, Skills and Abilities

Knowledge of office equipment (fax/copier) Proficient computer skills including word processing, spreadsheets, database Data entry skills Mathematical skills

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

7002 Value-Based Care and Network Services

Department

70028459 HCC Coding Services
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