Evolent Health Risk Adjustment Coder, Evolent Care Partners in Boston, Massachusetts
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Why We’re Worth the Application:
We continue to grow year over year.
Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts (https://www.evolenthealth.com/diversity) .
Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index making us a best place to work for LGBTQ+ equality.
Named to Parity.org’s 2020 list of the best companies for women to advance (https://www.evolenthealth.com/about-us/press-releases/8579/evolent-health-named-to-parity.org%E2%80%99s-best-companies-for-women-to-advance-list-2021) .
Continued to prioritize the employee experience and achieved an 87% overall engagement score on our last employee survey.
Published an annual DE&I report (https://dev.evolenthealth.com/sites/default/files-public/Evolent%20Health%202020%20DE%26I%20Annual%20Report.pdf) to share our progress on how we’re building an equitable workplace.
What You’ll Be Doing:
Under the direction of the Senior Director, Risk Adjustment Coding Strategy, you’ll collaborate with other ECP team members, leaders and Providers as needed. This role is an intricate part of the Risk Adjustment coding team and ECP programs. The goal is to support ECP’s coding strategy, tactics, and data capture processes to drive overall optimal Risk Adjustment coding performance.
ECP’s Risk Adjustment Coders will perform a comprehensive review of each Progress Note and will ensure the clinical documentation in the Progress Note supports the ICD-10 codes assigned to the claim to the highest level of specificity before submission. Compliance with Official Coding Guidelines in ICD-10-CM coding conventions, as well as CMS Risk Adjustment Data Validation (RADV) guidelines, is a must. The focus of this position is to confirm accuracy and specificity of diagnoses codes assigned on the claim are in accordance with the AHA ICD-10-CM coding guidelines, CMS clinical documentation guidelines, and RADV criteria.
This position may require communicating with the provider to obtain higher specificity for accuracy of code assignment. Clinical knowledge and high-level analytical skills are utilized in the review of each Progress Note to confirm support of appropriate ICD-10-CM code assignment for accuracy of risk score assignment and reimbursement. This role is specific to provider clinical documentation and the requirements of CMS for RADV and reporting.
Accurate coding with demonstration of knowledge in the principals and practices of ICD-10-CM and CPT conventions applies continuously. You must enjoy reading and demonstrate the ability to put clinical pieces of documentation together for diagnosis coding specificity, validation, and accuracy. Maintaining a high level of proficiency, productivity and accuracy with awareness and understanding of CMS RADV HCC compliance and guidelines will have you thriving in this position. Awareness, alertness, and the ability to understand the continuous changing guidelines and requirements for physician documentation and ICD-10-CM coding with excellent communication skills to mitigate risk to ECP is priority.
With use of the current programs, EMR, tools and resources, review ICD-10-CM diagnosis codes submitted on claims in conjunction with the clinical documentation in the Progress Note for accuracy of ICD-10-CM coding assignment to the highest level of specificity in a timely and efficient manner, maintaining productivity and accuracy:
Through Progress Note reviews, accurately communicate with providers using effective, necessary queries and communication through the specified method using only approved queries as this communication is part of the legal record. Prevent unnecessary interruption to Providers. Review all Provider queries, communications, and feedback with an open positive outlook. Build appropriate lasting relationships in the efforts to reduce Provider burn-out and mitigate risk.
Ensure diagnosis coding and clinical documentation criteria, rules and guidelines have been met in accordance with ECP policy and CMS guidelines.
Through Progress Note and clinical documentation reviews, recognize opportunities and trends for educational needs and outreach opportunities including, but not limited to, informatics, internal processes, and clinical workflow.
Recognize clinical signs, symptoms, and indicators for gaining the highest level of specificity via Provider queries to appropriately represent our patient’s disease burden for accuracy of risk score assignment. This also assists the Providers with meeting and maintaining the CMS documentation requirements.
Through Progress Note reviews and permissions, identify, and assist the providers in updating the patients Active Medical Problems List for diagnosis accuracy reflecting the highest-level specificity in the EMR descriptor and ICD code by appropriate methods.
Maintain effective, positive, and appropriate communication to ensure that your productivity and accuracy standards are met.
Actively participatein departmental provided seminars, training and/or boot camps to remain updated on any rules and changes regarding diagnosis coding and documentation requirements from appropriate credible sources. Although ECP will do its best to supply resources for continued education, you will need to independently seek CEU’s if needed to maintain your certification credentials through AAPC/AHIMA specific to your role.
Communicate and interact with Practice Performance Advisors, billing and/or coding compliance teams regarding proper coding and documentation requirements and processes. Present applicable questions, suggestions and/or information in a timely manner, as appropriate, and maintain awareness and understanding of internal processes.
Review all documentation ethically and thoroughly within the Progress Note using all applicable tools and resources (AHA coding clinic, ICD-10-CM/CPT manual, CMS guidelines, coder ethics, official coding guidelines), including communication with your supervisor, to apply understanding, knowledge, and skill set. Send queries to physicians where necessary.
Assist in the development and implementation of strategy for ECP’s risk adjustment and coding accuracy ensuring compliance with regulatory requirements.
Challenge status quo and develop innovative and out of box solutions to drive coding accuracy and optimization.
Observe market performance and provide guidance where needed to ensure market success in programs developed.
Contribute to the creation and maintenance of coding materials, review processes, workflow documents and policy & procedure implementation surrounding coding guidance and coding standards.
The Experience We Prefer:
Certified Risk Adjustment Coder certification (“CRC”) with experience working with Primary Care Providers, Payers and/or Billing including knowledge of ICD-10-CM diagnosis coding guidelines
2+ years in a Risk Adjustment HCC coding role
Ability to demonstrate accurate diagnosis code look up using the index to tabular in a current AHA ICD-10-CM expert for physicians coding manual (ECP will provide yearly updates)
RHIT /RHIA through AHIMA
Hands-on clinical experience (CNA, LPN, RN, MA)
Working knowledge of anatomy, physiology, and pathophysiology to understand disease processes, treatment, or management of conditions
Experience with MSSP ACO program, Value Based Care and/or Medicare Advantage
Experience working within variety of EMRs
2+ years of experience with analyzing risk adjustment and quality performance data
Experience leading a team of HCC coders to drive performance improvements
Client management experience, having demonstrated an ability to communicate effectively and partner with practices with the ability to engage, inspire, build credibility, and engender trust across all levels of an organization
Demonstrated ability to work productively, accurately, and independently
Accountability to consistently meet daily productivity expectations while maintaining a pre-determined level of coding quality and accuracy standards as set forth by the Risk Adjustment Department
High sense of confidentiality to protect patient health information and data according to HIPAA security
EHR experience with the ability to demonstrate how to navigate and research appropriately
Ability to travel to Partner sites if needed (Tier II or higher)
Awareness of ethical coding, the official coding rules, regulations, and coding conventions of the American Hospital Association (Coding Clinic), ICD-10-CM, Centers for Medicare and Medicaid Services (CMS), and organizational/institutional coding guidelines
Attention to detail, identify gaps and needs to improve organizational success
Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.
Compensation Range: The minimum salary for this position is $45,000, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.
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