Risk Analyst responsible for data analysis and portfolio optimization at PayJoy. Utilizing SQL and Python to enhance risk metrics and product profitability in emerging markets.
About the role
- Risk Adjustment Coder evaluating medical records to ensure accurate coding for health services. Collaborating with clinicians and providing training to improve documentation quality.
Responsibilities
- Evaluates and analyzes medical records for proper documentation.
- Identifies and communicates coding deficiencies to clinicians in order to improve documentation for accurate risk adjustment coding.
- Provides on-going training and education to the clinicians and physicians during 1:1, physician group, performance improvement and ad hoc meetings.
- Manages and trends data collection for HCC and other risk coding.
- Performs data mining from data captured through risk adjustment coding.
- Works with Manager and Director of VMG Quality Department to strategize and prioritize chart reviews and education.
- Assists with the development of action plans to improve documentation.
- Completes chart reviews for various Values Based Programs focusing on annual review of suspect chronic conditions; utilizes payer portals as necessary to complete annual coding reviews.
Requirements
- Minimum of two years records coding experience or equivalent
- Ability to perform functions in a Microsoft Windows environment
- Ability to be detailed oriented and perform tasks at a high level of accuracy
- Ability to make sound decisions
- Demonstrate good communication and team work skills
- Previous experience with an electronic legal health record system.
- Understand the anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses
- Understands medical coding guidelines and regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models.
- High School Diploma or GED required
Benefits
- medical/prescription, dental and vision insurance
- health and dependent care flexible spending accounts
- 403(b) (401(k) subject to collective bargaining agreement)
- paid time off
- paid sick leave as provided under state and local paid sick leave laws
- short-term disability and optional long-term disability
- colleague and dependent life insurance and supplemental life and AD&D insurance
- tuition assistance
- employee assistance program that includes free counseling sessions
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