HCA, Hospital Corporation of America Quality, Coding, and Risk Specialist in Foster City, California

The HCA Physician Services Group (PSG) is the physician and practice management solution for the Hospital Corporation of America (HCA). PSG operates more than 750 practices, Urgent Care Facilities, and partners with HCA’s 165 hospitals to structure employed provider programs, professional service agreements, and joint ventures that offer the communities we serve high quality, cost effective care. We manage a collection of highly motivated and innovative leaders who are committed to excellence in every aspect of their career .

The HCC & Risk Management Specialist’s primary function is to assist and educate physician providers on proper coding of all current medical conditions to the highest specificity according to Medicare requirements for the Hierarchical Condition Category (HCC) risk adjusted payment model. The HCC & Risk Management Specialist will also create helpful learning tools to serve as reference materials for the provider offices.

DUTIES AND ESENTIAL JOB FUNCTION

  1. Contact and visit physician provider offices regularly to review charts and ensure proper coding of all current medical conditions to the highest specificity according to Medicare requirements for the Hierarchical Condition Category (HCC) risk adjusted payment model.

  2. Educate providers and staff about HCC based guidelines and updates.

  3. Ensure that billing staff understand the importance of correctly adding diagnosis codes to claims.

  4. Conduct training sessions for physicians and/or staff as needed.

  5. Develop and maintain coding reference sheets by specialty.

  6. Update the HCC manual on a yearly basis to reflect any changes.

  7. Review reports and take appropriate actions accordingly.

  8. Communicate with providers and staff in case of any changes, updates and deadlines.

  9. Identify HCC conditions that require patient outreach, chart review or physician education.

    1. Manage retrospective chart reviews with vendors and health plans.

    2. Manage home health assessment programs with vendors.

    3. Work with health plans on achieving project goals.

    4. Other duties as assigned to support the success of HCC risk adjusted payment model program.

    QUALIFICATIONS

    REQUIRED

  10. ICD-10 Certified Professional Coding Certificate.

  11. Minimum 2 years coding and/or billing experience.

  12. Minimum 1 year experience with HCC coding and risk adjustment

  13. Knowledge of ICD-10 codes and taking courses as necessary to maintain certification.

  14. Proficiency in Excel and Word software programs.

  15. Excellent written and verbal communication skills.

  16. Ability to effectively communicate with physicians, and provider office staff.

  17. Ability to research clinical and non-clinical issues.

  18. Ability to maintain confidentiality.

    1. Ability to become technically proficient in Access Express and Ascender as well as reading reports.

    2. Ability to research and multi-task utilizing critical thinking skills.

    3. This position requires driving to Santa Clara County.

    OTHER FUNCTIONS AND RESPONSIBILITIES

    Perform other duties as assigned.

    REQUIRED LICENSES/CERTIFICATIONS

  19. ICD-10 Certified Professional Coding Certificate

    PREFERRED

  20. Experience in the medical field, working for a provider office or in a healthcare environment.

  21. Medical Billing certificate or equivalent years of experience.

  22. Knowledge of ICD-10 Codes.

  23. Knowledge of medical terminology and anatomy.

  24. Ability to prioritize tasks and work in a high volume production environment.

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INDRR

Title: Quality, Coding, and Risk Specialist

Location: California-Foster City-PPMSI

Requisition ID: 24614-51022