QCDI Coder

Job Summary and Responsibilities

As our Quality Clinical Documentation Improvement (QCDI) Coding Specialist, your primary focus will be to facilitate and ensure the comprehensive capture of billing data for the purpose of accurately reporting HCC's, participating in the reconciliation of patient medical and billing records, and identifying reimbursement/quality of care opportunities. Additionally this role will provide provider education and review trends of assigned provider or medical groups. The Hierarchical Condition Category (HCC) Quality Program was developed by CMS to promote quality care for Medicare Advantage members. By focusing on comprehensive documentation to identify, evaluate and assess chronic conditions at the appropriate specificity, patient medical needs are met at the highest level.

Every day you will perform comprehensive chart reviews to ensure documentation required to facilitate the reporting of HCC diagnoses to payer. You will also identify claims correction opportunities and submit to appropriate personnel for processing.

To be successful in this role, you will have an extensive knowledge of payer contract guidelines, a strong background in coding, and a high level of attention to detail.

As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

This position is work from home for residents of CA.

• Performs comprehensive chart reviews to ensure documentation required to facilitate the reporting of HCC diagnoses to payer

• Identifies claims correction opportunities and submits to appropriate personnel for processing

• Demonstrates analytical and problem-solving ability regarding review of submitted diagnosis codes versus services reflected in the documentation in the patient's chart note

• Follows department policies and guidelines on appropriate documentation to billing codes, abstracting information from chart notes based on performance program measures

• Partners with QCDI Nurse, as necessary, to identify trends and gaps for creating better process efficiency and provider performance

• Assists in the development and reporting of HCC and Pay for Performance Metrics

Job Requirements

Required

• 5 years experience as a clinic coder
• Extensive knowledge of payer contract guidelines
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
• Analytical and problem solving skills with the ability to understand clinical compliance guidelines, complex reimbursement structures and to apply contractual and governmental regulations to internal processes. Superior organizational skills. Superior written and verbal communication skills. Able to work with minimum daily supervision.

Preferred

• Bachelors degree or equivalent work experience preferred
• HCC, risk adjustment, or specialty coding experience preferred
• Experience with MSSP preferred
• Technical/software acumen preferred

Where You'll Work

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.