Clinical Documentation Coder And Educator

How you’ll help

UpStream is seeking a motivated, passionate, and knowledgeable Clinical Documentation Coder & Educator to enable our vision of care for our Medicare populations. As part of our Quality Team, you will interact with providers to ensure accurate and complete risk adjustment coding and work closely with UpStream internal stakeholders. You will perform audits of coded medical records to ensure accurate ICD-10 coding is supported by clinical documentation.

Additionally, in this role, you will help identify barriers to accurate and complete risk adjustment coding and make suggestions on improvements to include both practice and UpStream resources. You will provide support to internal and external team members related to risk adjustment questions, processes, and procedures as well as follow all UpStream Risk Adjustment processes and utilize UpStream tools and analytics.   

What you’ll do

• Approximately 90% of your time will be spent on clinical documentation and risk adjustment coding activities, including, but not limited to:
  • Assisting with prospective reviews and guiding the risk adjustment portion of the chart prep process. 
  • Completing concurrent and/or retrospective chart reviews on eligible members.
  • Responsible for chart review & ICD-10 diagnosis coding of risk adjustment eligible members.
  • Capturing supplemental diagnosis information for MA members.
  • Reviewing select medical records for accuracy of ICD-10 diagnosis codes.
  • Reviewing of accurate capture of medical severity of any applicable illness(es).
  • In depth documentation review, focusing on complete, accurate, specific, and supported chronic conditions.
  • Utilizing compliant Provider query process when unclear, inadequate, or confusing documentation is found in the medical record.
  • Creating tailored educational materials for Providers based on findings in documentation and coding.
  • Facilitating educational presentations to offices related to risk adjustment coding and coding processes.
• Approximately 10% of your time will be spent on miscellaneous risk adjustment related activities, including but not limited to:
  • Engaging in professional development activities.
  • Participating in training activities, group meetings, and other quality and accuracy activities. 
  • Developing a comprehensive understanding of risk adjustment programs and resources.
  • Developing and applying keen insight of our providers and our KPIs.
  • Building a strong, collaborative relationship with Provider groups.
  • All other related duties assigned at manager’s discretion.
  • Ability to maintain minimum productivity and accuracy standards.

Experience and skills you’ll need

• Current nursing licenses (LVN, LPN or RN) highly preferred.
• Minimum of three (3) years’ coding experience working in risk adjustment coding. Two (2) or more years’ experience in a primary care setting highly preferred and 1 year RAF coding experience required.
• CRC—Certified Risk Adjustment Coder credentials required.
• Active coding certificate required. AAPC or AHIMA coding certification preferred.
• Extensive knowledge of medical terminology, anatomy, physiology, and pharmacology.
• Extensive knowledge of hierarchical condition categories (HCC).
• Extensive knowledge of ICD-10-CM Official Guidelines for Coding and Reporting.
• Strong knowledge of Microsoft Office suite, primarily Excel and PowerPoint.
• Strong time management skills required.
• Ability to navigate within various EMRs (Electronic Medical Records).
• Strong interpersonal, communication (verbal, non-verbal and listening) skills.
• Critical thinking skills.
• Ability to create meaningful reports.
• Ability to work under minimal supervision after initial onboarding phase.
• Ability to remain productive under time constraints and meet deadlines critical to the business.