Senior Coding - Clinical Documentation Analyst

at  Arkos Health

Please note: Must reside and be fully authorized to work in the US. **We are seeking remote applicants, preferably in Arizona, Texas, New Mexico, Nevada, or any state except California, Colorado, New Jersey, New York, and Washington.

HOW YOU’LL MAKE A DIFFERENCE:

Arkos Health is seeking a Senior Coding - Clinical Documentation Analyst. The Arkos Health risk adjustment department is tasked with ensuring accurate documentation and coding of disease burden to enhance patient experience, reduce costs, improve health outcomes, and improve clinician experience. This position in the Risk Adjustment team will conduct prospective coding review in support of Arkos Health programs. The Clinical Documentation Analyst is tasked with analyzing patient medical records to identify clinical indicators that support an underlying diagnosis, with the intention of presenting these findings to a clinician for subsequent face-to-face assessment. The Clinical Documentation Analyst will utilize historical data, existing Electronic Health Record (EHR) tools and other technologies to pinpoint potential diagnoses that may impact the member’s health status. The prospective process involves prioritizing clinical indicators suggestive of an underlying condition. Success in this role is demonstrated through the adept adjudication of the review process, determining whether the clinical indicators are sufficiently robust to warrant presentation to a clinician for further consideration.
Maintaining a consistent accuracy rate of 95% or higher and meeting productivity standards established by leadership are essential expectations for proficiency in this position.

Essential Duties and Responsibilities:

• HCC/Risk Adjustment Expertise: Exhibits proficiency in conducting precise and thorough patient medical record reviews for Hierarchical Condition Categories (HCC) and Risk Adjustment conditions
• Advanced Knowledge: Possesses advanced comprehension of HCC/Risk Adjustment, coding, and documentation requirements
• Clinical Indicator Review: Examines patient medical records for clinical indicators sourced from diverse channels, including chronic diagnoses, targeted year data, procedures, medications, lab values, diagnostic reports, specialist visits, clinical assessments, notes, patient correspondence, education materials, physical examination findings, symptoms, durable medical equipment, patient-generated data, and prior authorizations
• Systems proficiency and agility: Document with confidence and ease requested information from the medical record into Excel spreadsheets or in a web-based review tool
• Attention to Detail: Demonstrates exceptional attention to detail throughout the review process
• Productivity and Accuracy: Maintains a consistent accuracy rate of 95% or higher. Consistently meets productivity standards established by leadership
• Staying Current: Stays abreast of changes in coding and documentation guidelines and rules
• Team Collaboration: Works effectively and efficiently within a team environment
• Adaptability: Adapts to changing priorities and displays a willingness to fulfill team needs
• Confidentiality and Compliance: Understands and adheres to policies and procedures for maintaining patient record confidentiality, HIPAA compliance, and system security
• Independence and Supervision: Demonstrates the ability to work independently under the supervision of department leadership

QUALIFICATIONS AND SKILLS:

• Two years of prospective chart review experience including suspect identification and querying providers
• Familiarity with anatomy and physiology, disease processes and medical terminology
• One year of specialized retrospective chart review experience (Medicare Advantage, ACA, or Medicaid Risk Adjustment)
• CRC and CPC or CCS (Required)
• Proficiency in Computer Systems including EHR systems, intermediate Excel skills
• Experience in delivering documentation and coding feedback to clinicians other than email or querying (preferred)
• Experience working for payor, population health organizations, or large medical groups (preferred)
• Auditing experience (preferred)
• Certified Documentation Expert Outpatient (CDEO)® certification (preferred)

• HCC/Risk Adjustment Expertise: Exhibits proficiency in conducting precise and thorough patient medical record reviews for Hierarchical Condition Categories (HCC) and Risk Adjustment conditions
• Advanced Knowledge: Possesses advanced comprehension of HCC/Risk Adjustment, coding, and documentation requirements
• Clinical Indicator Review: Examines patient medical records for clinical indicators sourced from diverse channels, including chronic diagnoses, targeted year data, procedures, medications, lab values, diagnostic reports, specialist visits, clinical assessments, notes, patient correspondence, education materials, physical examination findings, symptoms, durable medical equipment, patient-generated data, and prior authorizations
• Systems proficiency and agility: Document with confidence and ease requested information from the medical record into Excel spreadsheets or in a web-based review tool
• Attention to Detail: Demonstrates exceptional attention to detail throughout the review process
• Productivity and Accuracy: Maintains a consistent accuracy rate of 95% or higher. Consistently meets productivity standards established by leadership
• Staying Current: Stays abreast of changes in coding and documentation guidelines and rules
• Team Collaboration: Works effectively and efficiently within a team environment
• Adaptability: Adapts to changing priorities and displays a willingness to fulfill team needs
• Confidentiality and Compliance: Understands and adheres to policies and procedures for maintaining patient record confidentiality, HIPAA compliance, and system security
• Independence and Supervision: Demonstrates the ability to work independently under the supervision of department leadershi