Medical Encounter Analyst

Oakland, California

Responsible for the creation and auditing of all monthly and ad hoc outbound encounter/HCC reporting as well as analysis of inbound reports. The role performs data analysis and works with internal and contracted providers to meet compliance thresholds.

The annual salary range for the Medical Encounter Analyst at Center For Elders Independence is $ 58,514 to $87,760. This annual rate is based on the market for the Encounter Data Analyst position, and final offer will be based on experience, skills, abilities and work history. This role is eligible for benefits.

General Duties and Responsibilities:

Ensure that all encounters and HCCs are corrected according to industry standards and guidelines set by CMS and DHCS. Interprets, analyzes, and assigns diagnostic/HCC codes to ensure compliance with governmental reimbursement policies, regulations and applicable guidelines.

Researches, analyzes, and responds to inquiries regarding compliance, coding, and financial impact of coded diagnoses.

• Conduct Root Cause analysis for encounter/HCC errors and initiate process improvement or communications to resolve future occurrence.
• Ability to reviews and analyzes medical documentation and diagnosis listed accurately reflects the care and treatment.
• Establish and maintain strong relationships with Health Plans, Encounter Clearing Houses, external auditors/vendors, and internal stakeholders to fix, prevent, and to obtain extra support in resolving encounter and HCC coding errors.
• Assigns a variety of diagnostic codes in ICD 10 CM with careful attention to the PACE HCC reimbursement model.
• Create daily and weekly reports highlighting the correlation of patterns, trends, etc.

Qualifications:

• Bachelor’s Degree in Health Information Administration and two years of medical coding experience; or four years as a medical coder.
• One of the following Coding Certifications
• Certified Professional Coder
• Certified Coding Specialist
• Other AHIMA or CPC certification specific to HCC/Risk Adjustment Coding

Additional Job Requirements:

• Read and understand complex medical record information and clarify diagnoses/procedures and sequencing of diagnoses as required.
• Clearly communicate medical coding related information to practitioners and others involved in the care or treatment.
• Analyze and resolve complex medical coding issues.
• Experience with eClinicalWorks (eCW) favored.
• Coding experience with a HCC Model is strongly preferred.
• Must maintain current coding credentials.