HCA, Hospital Corporation of America HCC Risk Management Specialist PPMSI in Foster City, California

Exciting opportunity to join the nation's largest provider of healthcare services!

HCA Healthcare is a national leader in providing modern, culturally competent, patient-centered care and we are driven by a single goal:/the care and improvement of human life./

We are currently looking for an exceptional HCC Risk Management Specialist to join our team. We believe in our team and your ability to help us provide high quality, compassionate care in the communities we serve.

Pacific Partners Management Services (PPMSI) is a managed services organization formed in 1997 with administrative offices located in Foster City, CA. We provide services to IPAs in the Santa Clara and Monterey Bay areas. Our managed care and ACO services support approximately 1,000 independent physicians and include executive management, full financial services, utilization management, quality improvement, credentialing, contracting, claims processing and provider and member network services.

PPMSI is part of HCA Physician Services Group (PSG), the physician and practice management solution for the Hospital Corporation of America (HCA). PSG operates more than 750 practices, Urgent Care Facilities, and partners with HCA’s 165 hospitals to structure employed provider programs, professional service agreements, and joint ventures that offer the communities we serve high quality, cost effective care. We manage a collection of highly motivated and innovative leaders who are committed to excellence in every aspect of their career.

We offer an excellent benefits package, competitive salary, tuition reimbursement, and growth opportunities. We are seeking a great addition to the team who feels patient care is as important as we do!

Interested in learning more about us? Click here!

POSITION SUMMARY: The HCC & Risk Management Specialist’s primary function is to assist and educate physician providers on proper coding of all current medical conditions to the highest specificity according to Medicare requirements for the Hierarchical Condition Category (HCC) risk adjusted payment model. The HCC & Risk Management Specialist will also create helpful learning tools to serve as reference materials for the provider offices.

DUTIES AND ESENTIAL JOB FUNCTION

  1. Contact and visit physician provider offices regularly to review charts and ensure proper coding of all current medical conditions to the highest specificity according to Medicare requirements for the Hierarchical Condition Category (HCC) risk adjusted payment model.

  2. Educate providers and staff about HCC based guidelines and updates.

  3. Ensure that billing staff understand the importance of correctly adding diagnosis codes to claims.

  4. Conduct training sessions for physicians and/or staff as needed.

  5. Develop and maintain coding reference sheets by specialty.

  6. Update the HCC manual on a yearly basis to reflect any changes.

  7. Review reports and take appropriate actions accordingly.

  8. Communicate with providers and staff in case of any changes, updates and deadlines.

  9. Identify HCC conditions that require patient outreach, chart review or physician education.

    1. Manage retrospective chart reviews with vendors and health plans.

    2. Manage home health assessment programs with vendors.

    3. Work with health plans on achieving project goals.

    REQUIRED

  10. ICD-10 Certified Professional Coding Certificate.

  11. Minimum 2 years coding and/or billing experience.

  12. Minimum 1 year experience with HCC coding and risk adjustment

  13. Knowledge of ICD-10 codes and taking courses as necessary to maintain certification.

  14. Proficiency in Excel and Word software programs.

  15. Excellent written and verbal communication skills.

  16. Ability to effectively communicate with physicians, and provider office staff.

  17. Ability to research clinical and non-clinical issues.

  18. Ability to maintain confidentiality.

    1. Ability to become technically proficient in Access Express and Ascender as well as reading reports.

    2. Ability to research and multi-task utilizing critical thinking skills.

    3. This position requires driving to Santa Clara County.

    REQUIRED LICENSES/CERTIFICATIONS

  19. ICD-10 Certified Professional Coding Certificate

We believe in going above and beyond, and feel that there is no nobler pursuit than that of caring for and improving human life. We hope you’ll join us on our mission!

Job: *Quality Risk & Safety

Title: HCC Risk Management Specialist PPMSI

Location: California-Foster City-PPMSI

Requisition ID: 24614-67384