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Clinical Review Quality Control Coordinator - GRIPA

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Job ID REQ_97112 FACILITY Various Locations LOCATION Rochester, New York

Introductory Summary

Here is a great opportunity to work for a thriving business that is an industry leader in the Healthcare risk adjustment market. Cognisight is a customer focused business that combines a data driven approach with healthcare expertise to achieve great results. As an employee of Cognisight, you will enjoy working with an energetic team of coworkers and a leadership team that is highly engaged in the organization and the industry.

Job Objectives

This position will be responsible for, in conjunction with the Coding Director, developing and executing a structured Quality Control Plan that includes all lines of business and covers both new and existing reviewers.

Job Responsibilities

In conjunction with the Coding Director, develops and executes a structured Quality Control Plan that includes all lines of business and covers both new and existing reviewers. Works collaboratively with the Coding Director, Manager, Coding & Clinical Review, and Team Leads to assure quality & accuracy standards among all team members, as defined by management. Calculates and reports monthly accuracy rates of team members to Coding Director and Manager, Coding & Clinical Review. Conducts one on one feedback sessions with individual team members at Manager’s discretion. Mentor remote contracted staff. Attend monthly coding huddles in person or by Webex. Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision. Understands, respects, and applies client specific guidelines. Act as a Coding Liaison for Cognisight clients, including client calls. Adheres to audit review schedules to meet client expectations. Shares trends (positive & constructive) with Coding Manager & Team Lead for consultation and collaboration with client. Demonstrates agility to meet client needs. Assure accurate documentation when coding all lines of business to support RADV audits. Supports RADV client audits for all lines of business. Participates on client & prospect conference calls and face to face meetings as needed. Assure adherence to and currency with CMS/HHS guidelines. Assure adherence to and currency with DOH guidelines. Assure adherence to and currency with HIPAA, HITECH and Fraud Waste & Abuse. Assure adherence to and currency with medical coding protocols. Conduct is consistent with the Cognisight Code of Conduct. Collaborative input to Cognisight policy and procedure development & updates. Provides clinical intellect and expertise to system analytics via project assignment as well as on an ad hoc basis. Participates as a collaborative member of the Cognisight/GRIPA team.

Preparation and Training Required

Coding credential required RHIT, RHIA, CCS, CPC and supplemental CRC

Ability to use a variety of software including Excel

Ability to work on a team is a must

Must be comfortable giving constructive confidential feedback

Required Experience

Minimum of SIX years HCC coding experience

Thorough knowledge of risk adjustment methodologies including MA,PACE, HIX and MMC

Please forward resume to

Thank you.

Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran
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