HEDIS Coding Specialist (Remote Option-NC)

Competitive Compensation & Benefits Package! Position eligible for –

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details. Office Location: Remote Option; Available for any of Partners' NC locations (or within 40 miles of NC border) Closing Date: Open Until Filled Primary Purpose of Position: The HEDIS Coding Specialist plays a critical role in ensuring accurate and compliant coding, documentation improvement, and adherence to National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. With a background in medical coding and clinical practice, the specialist is responsible for reviewing medical records, identifying appropriate diagnosis codes, and ensuring documentation supports coding accuracy. Additionally, they collaborate with healthcare providers to address incomplete or missing clinical documentation, educate on proper coding practices, and facilitate training sessions as needed. By conducting audits, analyzing data, and communicating with internal and external stakeholders, the specialist helps improve coding accuracy, optimize revenue, and enhance the quality of care delivered to patients. Their meticulous attention to detail, strong analytical skills, and compliance expertise contribute to the organization's success in meeting HEDIS reporting requirements and achieving quality improvement goals. Role and Responsibilities: 1. Coding Review: Conduct thorough reviews of medical records to ensure accurate coding and documentation in compliance with National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements. 2. Documentation Improvement: Identify opportunities for documentation improvement to support accurate coding and ensure alignment with coding guidelines and regulatory standards. 3. Provider Education: Collaborate with healthcare providers to educate them on proper documentation practices, coding guidelines, and HEDIS measures. Provide guidance and support to facilitate accurate coding and documentation. 4. Auditing: Perform audits to assess coding accuracy and completeness. Identify discrepancies, coding errors, and areas for improvement through audit findings. 5. Risk Adjustment Coding: Apply expertise in risk adjustment coding to accurately capture and report diagnosis codes relevant to Hierarchical Condition Categories, Risk Adjustment and Managed Care Contract reimbursement initiatives. 6. Data Analysis: Analyze coding and documentation data to identify trends, patterns, and opportunities for improvement. Use data-driven insights to develop strategies for enhancing coding accuracy and documentation completeness. 7. Quality Assurance: Ensure compliance with coding and documentation guidelines, regulatory requirements, and organizational standards. Monitor coding practices and documentation processes to maintain quality and integrity. 8. Provider Support: Serve as a resource for healthcare providers, offering guidance, feedback, and assistance with coding-related inquiries, coding challenges, and documentation queries. 9. Training and Development: Develop and deliver training sessions, workshops, or educational materials to healthcare providers and coding staff on coding best practices, documentation requirements, and HEDIS measures. 10. Collaboration: Collaborate with cross-functional teams, including Quality Improvement, Provider Relations, and Data Analytics, to support quality improvement initiatives, address coding-related issues, and achieve organizational goals. 11. Reporting: Generate reports and documentation to track coding accuracy, documentation improvement efforts, and compliance with HEDIS measures. Communicate findings and recommendations to stakeholders as needed. 12. Continuous Learning: Stay abreast of updates, changes, and advancements in coding guidelines, documentation standards, and regulatory requirements. Continuously enhance knowledge and skills through professional development opportunities. Knowledge, Skills and Abilities: Knowledge: 1. Medical Coding: Comprehensive understanding of ICD-10-CM, CPT, and HCPCS coding systems, including knowledge of coding conventions, guidelines, and updates. 2. HEDIS Measures: Familiarity with National Committee for Quality Assurance (NCQA) HEDIS measures, specifications, and reporting requirements. 3. Risk Adjustment: Understanding of risk adjustment methodologies and concepts, including Hierarchical Condition Categories (HCCs) and CMS risk adjustment models. 4. Clinical Documentation: Knowledge of clinical documentation standards, terminology, and practices to ensure accurate coding and documentation