Coding Quality Specialist

Full-Time

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

The job

Effectively interface with provider partners and vendors to monitor, implement and perform HCC Risk Adjustment Data Validation coding and projects.

You will

• Perform risk adjustment data validations using AHA Coding Guidelines.
• Review reports and clinical chart notes to identify areas of deficiency in order to provide accurate coding summaries to SCAN’s physician network.
• Monitor HCC coding performed by outside vendor to ensure accuracy; provide feedback and make corrections as needed. Review medical records to ensure accuracy of the HCC codes. Ensure diagnosis information is present in order to support and validate the code.
• Maintain a comprehensive tracking and management tool (i.e. Physician Group HCC Business Plan) for assigned network. Track all HCC activities for assigned medical groups and ensure that all tasks are completed in a timely manner.

Develop an understanding of the encounter data transmission processes for all groups and their affiliated capitated hospitals.

Monitor key indicators within group's utilization infrastructure. Monitor the implementation of Corrective Action Plans as needed, and track implementation as it relates to HCC activities and high risk patients, especially in ensuring that those patients have appropriate medical record problem lists and corresponding risk score.

• Ensure compliance of New Physician Groups and provide coding expertise as well as administrative support to ensure successful integration of SCAN’s coding initiatives.
• Perform HCC audit activities as it relates to the assigned groups. Assist with development of Corrective Action Plans and continued monitoring.

Perform CMS Data Validation activities, including record selection, tracking and submission, in conjunction with the RADV Operations Supervisor.

Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.

• Contribute to team effort by accomplishing related results as needed.

Your qualifications

• Bachelor’s Degree, preferred.
• Certified Coding Specialist (CCS) or CPC required.
• 1-2 years of coding experience, preferred.
• Knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes; and pharmacology.
• Knowledge of medical codes involving selections of most accurate and descriptive codes using the ICD-9 – CM, Volumes 1-3.
• Knowledge of paper based medical records and electronic medical records for inpatient and outpatient records.
• Ability to follow instructions and work independently.
• Experience in a documentation and training environment preferred.
• Ability to meet and maintain production and accuracy metrics, as defined.
• Ability to research diagnoses and apply clinical knowledge to daily operations.
• Proficient in MS Office.

What’s in it for you?

• A competitive compensation and benefits program
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• A work-life balance
• An opportunity to become part of a team that makes a difference to our members and our community every day!

Covid-19 Vaccination Policy

To ensure a healthy and safe work environment, if you are selected for this position, your job offer with SCAN Health will be contingent upon being fully vaccinated and providing proof of your COVID-19 vaccine within 3 days after your start date. Generally, you are considered fully vaccinated 14 days after receiving the last dose, as recommended by the manufacturer, of a vaccine that has been authorized by the FDA for use in the United States, including vaccinations that have been approved pursuant to an Emergency Use Authorization. If fully vaccinated outside of the United States, the vaccination must be listed for emergency use by the World Health Organization (WHO). If you cannot receive the vaccine because of a disability/medical reason or sincerely-held religious belief, you may request an accommodation to this requirement by contacting COVID-19 Vaccination Policy. Learn more about the COVID-19 vaccination here - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Long Beach, CA 90806: Reliably commute or planning to relocate before starting work (Required)

Experience:

• ICD-10: 1 year (Preferred)

Work Location: Hybrid remote in Long Beach, CA 90806

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