Job Description

Nemours is looking for a Risk Adjustment Coding Analyst to work in our Medical Management division in Wilmington, Delaware. The Risk Adjustment Coding Analyst is responsible for assisting Risk Scoring Improvement by review of medical records, analysis of clinical ICD-10 diagnosis documentation and providing risk adjustment education with the goal of identifying and communicating missing gaps in clinical documentation, conflicting diagnoses, and unspecified diagnoses.

This is a remote position. Local travel to Nemours Primary Care sites required.
Primary Responsibilities:

• Assists with review medical records for documentation opportunities and problem list accuracy. Reviews clinical status of patient, current treatment plan and past medical history and identifies potential gaps in physician documentation.
• Assists with educating staff and providers on documentation principles and assists in communicating program metrics through dashboards and various reports.
• Assists with identifying and arranging education for new providers soon after onboarding- develop educational offerings for new providers.
• Expert knowledge of EHR use and tools available for clarification presentation and tracking.
• Maintain expert knowledge of current changes of ICD 10 requirements and HEDIS measures and educate providers to needed changes in documentation.
• Identifies strategies for sustained work process changes that facilitate complete and accurate clinical documentation.
• Maintain open communication with CDI and coding staff to accurately reflect the diagnoses.
• Actively seek new opportunities to review records and offer documentation education and advice-inpatient, ED, outpatient specialty and primary care clinics.
• Post-coding review of charts for diagnosis coding accuracy.

• Coding certification required. CPC, COC, or CRC preferred.
• At least 1-2 years of related coding experience

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