Medicare Advantage Medical Abstract Analyst II - Southfield Job
Henry Ford Health - Southfield, MI

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Medicare Advantage Medical Abstract Analyst II - Southfield

Requisition #: 75662
Status: Full-Time with Full-Time Benefits (40 Hours)
Business Unit: Health Alliance Plan (HAP)
Shift: Days
Department: Medicare Advantage Risk Adjustment
Weekends: No
Job Family: Accounting/Finance
Job Function: Business (Non-Clinical)
Campus/Job Location Health Alliance Plan (HAP) Preferred
Location (State/City): US-MI-Southfield

Overview

Our health system thrives on teamwork, and we know our employees achieve the greatest results when they are working together for a common goal - to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you!

Henry Ford Health System is one of the country's largest health care systems and a national leader in clinical care, research and education. Our system includes the 1,200-member Henry Ford Medical Group, six hospitals, Health Alliance Plan, 32 primary care centers and many other health-related entities throughout Southeast Michigan. Founded in 1915 by auto pioneer Henry Ford, we continue to be committed to improving the health and well-being of a diverse Michigan community. In 2009 alone, Henry Ford Health System provided more than $173 million in uncompensated care. Henry Ford also is a major economic driver in Michigan and employs more than 23,000. Our health system is led by CEO Nancy Schlichting.

Responsibilities

Primary Objective

Under minimal supervision using established procedures, abstracts medical information from various sources in the patient medical record for HAP and AHL MA membership. Designs and works with forms for collection of data and performs surveillance checks to monitor the accuracy of data. Ensures appropriate documentation and data collection according to specific project or audit requirements. Provides for quality assurance activities and coordinates auditing processes with leadership. Work collaboratively with various HAP departments and HAP's provider community to obtain accurate submission of risk adjustment data through coordinated medical chart review activity. Promote education on the importance of comprehensive medical record documentation and correct coding. Position is responsible for maintaining a culture of integrity through coding compliance and adherence to CMS program guidelines.

Duties and Responsibilities

-1. Work with Manager to target member/providers for retrospective, prospective, and CMS data validation projects for risk adjustment utilizing DCA RAP system and other tools through analysis and problem solving.

-2. Complete chart reviews or audits for retrospective, prospective and audit projects on DCA systems assigned by Manager, following HAP's Coding Compliance Guidance, Audit and other projects' policies and procedures.

-3. Maintain control reports if required by project

-4. Support development of education activities/materials for Risk Adjustment to increase the understanding of the importance of accurate coding and supporting medical record documentation

-5. Participate in Coding Compliance Work Group.

-6. Complete appropriate paperwork/documentation/system entry/storage retention regarding claim/encounter diagnosis information for provider medical records, audits, and other special projects.

-7. Participate in continuing education activities to improve knowledge of job performance or to maintain credentialing.

8. Perform other related duties as assigned.

- Essential Functions.

Qualifications

Requirements

A. Education

1. Bachelor Degree, Health Information Administration (HIA) or Associate degree, Health Information Technology (HIT) required

B. Experience

1. Minimum of two (2) years coding experience in diagnostic and procedure coding

2. Prior experience working with physicians/medical groups/physician offices preferred

3. ICD-9 coding experience/proficiency strongly preferred

4. Knowledge of medical billing and third party payer regulations preferred

C. Certification

1. Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) required, CCS, CCS-P, CPC preferred

D. Behaviors / Abilities

1. Excellent quantitative, analytical, and problem solving skills

2. Excellent written and oral communication skills

3. Strong ability to work independently with limited direct supervision

4. Ability to work with automated systems.

5. Ability to work across multi disciplinary teams

6. Ability to organize and manage multiple priorities and/or projects

7. Strong work ethic, reliable, resourceful, with enthusiastic attitude

E. Knowledge

1. Knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems

2. Knowledge in the use of Microsoft Office products

3. Knowledge of computer software programs used for data collection

4. Knowledge of Medicare Advantage risk adjustment payment methodology preferred

5. Knowledge of CMS programs, processes, and payment principles preferred.

Equal Employment Opportunity / Affirmative Action Employer

Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, national origin, sex, sexual orientation, age, disability, religion, weight/height, marital status, familial status, veteran status or any other characteristic protected by law.

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Built around a hospital founded by Detroit's favorite son, the not-for-profit Henry Ford Health System (HFHS) is a hospital network...