Senior Coding Analyst, Risk Adjustment (Hybrid)

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

The Senior Coding Analyst (SCA) reports to the Lead Coding Analyst.The SCA is primarily responsible to assist with identifying gaps in submissions, ensuring correct data quality issues and areas of coding improvements for CMS Risk Adjustment and Quality Incentive programs. The SCA is responsible to continuously educate physician and staff on correct and acceptable HCC coding. The SCA will discuss missed opportunities of diagnosis with physician and office staff which will assist with consistent charting and identification of HCC. The SCA will assist with data collection for CMS Sweeps. The SCA will participate in the Annual Wellness chart review to ensure practitioners are charting appropriately and identifying possible improvement. The SCA will mentor entry level Coding Analyst for a minimum of 12 months. During that time the SCA will educate and monitor the Coding Analyst in order to eventually allow coding analyst to work independently.

Required Skills

• Excellent oral and written communications
• Ability to learn quickly
• Strong organizational skills
• Data entry skills
• Strong knowledge of ICD-10 coding

Required Experience

• High School diploma or equivalent.
• Three years’ experience performing medical group related billing, claims, medical assisting or medical records.
• Knowledge of Medical Terminology, Anatomy, Physiology, Pharmacology and Disease Processes
• ICD-10 Certified/Proficient
• Certified Professional Coder (CPC) required.
• Certified Risk Adjustment Coder (CRC) preferred
• Microsoft Office: Word, Excel and Power Point
• Computer keyboarding is required.