HCC Coding Analyst

Clinical / Medical | Orange, CA

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The HCC coding analyst is responsible for partnering with local and regional medical center physicians and operations staff, under the guidance of the coding manager, to oversee the quality of both outpatient and inpatient coded clinical and administrative data.  The HCC coding analyst is responsible for synthesizing audit findings to provide actionable feedback to physicians and administrators on areas of improvement.  This position is expected to become an active participant in continuous quality improvement processes and workgroups with a strong partnership with the coding manager, coding director and clinical staff. Compile, process, and maintain medical records of hospital and clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the health care system. Process, maintain, compile, and report patient information for health requirements and standards in a manner consistent with the healthcare industry's numerical coding system.

General Duties/Responsibilities:

(May include but are not limited to)

  • Assure compliance of operational processes and member encounter data making determinations with respect to appropriateness of documentation adherence to federal, state and local regulations.
  • Work with coding manager to review audit findings to identify coding risk areas and ensure that training activities are addressing these areas.
  • Identify through focused audits operational and regulatory issues related to coding, documentation and compliance requirements, ensuring that appropriate documentation is maintained to comply with federal and state requirements.
  • Using independent judgment and sensitivity, review with individual physicians their audit findings and make suggestions for coding improvements.
  • Monitor corrective actions for audit review findings.
  • Conduct confidential audits for providers who present a risk due to special circumstances or prior audit issues.
  • Prepare and/or perform regional and medical center auditing analysis and/or special projects as assigned.
  • Assist in developing and implementing policies and procedures/compliance audit standards to ensure compliance w/ federal, state and other regulatory requirements.
  • Protect the security of medical records to ensure that confidentiality is maintained.
  • Review records for completeness, accuracy, and compliance with regulations.
  • Retrieve patient medical records for physicians, technicians, or other medical personnel.
  • Assign the patient to diagnosis-related groups (DRGs), using appropriate computer software.
  • Process patient admission or discharge documents.
  • Transcribe medical reports.
  • Resolve or clarify codes or diagnoses with conflicting, missing, or unclear information by consulting with doctors or others or by participating in the coding team's regular meetings.
  • Enter data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment into computer.
  • Identify, compile, abstract, and code patient data, using standard classification systems.
  • Release information to persons or agencies according to regulations.

Minimum Requirements:

  • Bachelors Degree or equivalent experience in finance/business, medical records technology, health services administration, nursing or other ancillary medical area.
  • Certification in one of the following: Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), and three or more years of coding experience.

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