Anthem, Inc. Risk Adjustment, Clinical Document Improvement Specialist/Coding-Remote in Indianapolis, Indiana
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Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.
Risk Adjustment, Clinical Document Improvement Specialist/Coding *This is a remote position
Summary: Responsible for conducting retrospective and concurrent medical reviews to assess medical record documentation and monitoring codes on claim/encounters for Medicare Risk Adjustment.
Primary duties include, but are not limited to:
Conducts concurrent medical record and claims review to assess medical record documentation practices and accuracy/sufficiency of policies and procedures. Verifies accuracy/appropriateness of submitted diagnosis codes based on medical record documentation looking at both ways 1) appropriate detail in the medical record is not captured in what is reported, and 2) when reported information is not supported by details in the medical record.
Provides feedback to providers on performance improvement opportunities; tracks and prioritizes projects to improve coding and documentation outcomes.
Develops and implements action plans to address issues identified through data analysis.
Provides oversight, guidance, and training to partner providers and clinicians related to CMS guidelines and HCC best practices.
Develops training programs and tools; performs internal process and policy audits.
Conducts on-going review, monitoring and communications to promote and ensure adherence to established protocols and best practices.
Reviews documentation of well visits (annual well visits and other routine and preventative visits) including the use of appropriate modifiers for telehealth visits, HEDIS scoring accuracy, etc.
Requires a minimum of 2 years’ experience with all types of medical records (including Medicare Risk Adjustment and evaluation and management coding) in a physician practice setting or large group practice, and includes educating providers on clinical documentation needs.
Certified Clinical Documentation Specialist (CCDS, CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Improvement Professional (CDIP) required.
Current Certified Professional Coder certification (CPC, CPC-H, CCS, CCS-P or CRC) preferred.
Additional experience in diagnostic clinical coding preferred. Clinical experience or background (e.g. RN, LPN, foreign medical graduates) preferred.
Travel within the city to various care centers is required as needed.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.