Clinical Chart Reviewer

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes more than 10,000 primary care and specialist physicians delivering services to over 200,000 members enrolled in Commercial, Medicare and Medicaid products.

Our Management Services Organization employs over 200 skilled staff professionals dedicated to ensuring practices deliver the highest quality of care to their patients while efficiently utilizing healthcare resources. HCP's vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP's mission of serving our members by facilitating the delivery of quality care.

Interested in joining our successful Garden City Team? We are currently seeking a Clinical Chart Reviewer. Position Summary: Healthcare Partners is a leading healthcare organization dedicated to providing high-quality healthcare services to our patients.

We are currently seeking a detail-oriented and experienced HCC Clinical Chart Reviewer to join our team. The HCC Clinical Chart Reviewer will play a vital role in reviewing and analyzing patient medical records to ensure accurate documentation of Hierarchical Condition Categories (HCC) for proper reimbursement and risk adjustment. Essential Job Functions / Responsibilities: Perform prospective reviews patient on medical charts for documentation, and other relevant records to identify, validate, and suggest potential HCCs to the providers for pre-charting.

Perform retrospective reviews of medical records to identify opportunities for capturing missed or undocumented HCCs. Work under the leadership of the Director of RA in stratifying the number of charts to review in optimizing risk adjustment revenue. Analyze clinical data, including diagnoses, procedures, and treatments, to accurately assign and document HCC codes.

Ensure compliance with coding guidelines, regulatory requirements, and best practices related to HCC coding and documentation. Collaborate with healthcare providers, coders, and other stakeholders to obtain missing or incomplete medical information necessary for accurate coding. Conduct comprehensive assessments of medical records to identify documentation gaps, discrepancies, and areas for improvement in HCC coding.

Communicate coding and documentation discrepancies and provide feedback to healthcare providers and coders for continuous improvement. Participate in coding and documentation improvement initiatives, including training sessions and educational programs, to enhance coding accuracy and compliance. Stay updated with the latest changes in coding regulations, HCC coding guidelines, and industry trends.

Collaborate with cross-functional teams, such as physician trainer, coding, compliance, billing, Provider relations and Quality departments, to resolve coding-related issues and ensure accurate reimbursement. Maintain confidentiality and adhere to all HIPAA (Health Insurance Portability and Accountability Act) regulations in handling patient information. Assist in the development and implementation of quality assurance programs to monitor and evaluate coding accuracy and compliance.

Provide guidance and support to coding staff on HCC coding queries and documentation requirements. Qualification Requirements: Skills, Knowledge, Abilities Bachelor's degree in Nursing, or a related field.(LVN, RN, BSN) or International Medical Degree (MBBS or MD). A relevant coding certification (such as CPC, CRC or CCS).

Proven experience as an HCC coder, with a strong understanding of HCC coding principles, guidelines, and practices. In-depth knowledge of ICD-10-CM coding and CMS HCC coding guidelines. Proficiency in using coding software and electronic health record (EHR) systems.

Strong analytical and problem-solving skills, with excellent attention to detail. Effective communication skills, both written and verbal, to collaborate with healthcare providers and other stakeholders. Ability to work independently and prioritize tasks to meet deadlines in a fast-paced environment.

Up-to-date knowledge of industry trends, changes in coding regulations, and best practices. Commitment to maintaining the highest standards of accuracy, integrity, and compliance in coding practices. Proven experience as a Clinical Chart Reviewer with a focus on HCC coding and documentation.

Familiarity with CMS (Centers for Medicare and Medicaid Services) HCC coding guidelines and risk adjustment methodologies. Excellent understanding of medical terminology, disease processes, and clinical documentation practices. .

Training/Education: Bachelor's degree in Nursing, or a related field.(LVN, RN, BSN) or International Medical Degree (MBBS, MD) AHIMA or AAPC certification such as CCS, CCS-P, CPC or CRC Experience: Minimum of two years of risk adjustment coding experience. preferably within a managed care or IPA setting. HCC and risk adjustment model experience strongly preferred Prior experience in working with Providers required Salary Information: Annual Base Compensation: $90,000-105,000 Bonus Incentive: Up to 5%, based on organizational performance HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.

In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Department: Risk Adjustment This is a non-management position This is a full time position