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Risk Adjustment Analyst- HIM CDI

This job posting is no longer active.

Job ID: 16450
Location: Chapel Hill, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description


Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.


The Risk Adjustment Coordinator will be responsible for analyzing and auditing medical records retrospectively as requested by
insurance companies as required by the third party payer under the value care contracts. In addition, the Risk Adjustment Coordinator will be responsible for
working the EPIC WQ to reorder the Hierarchical Condition Categories (HCC) conditions in the top 12 for claim generation. The Risk Adjustment Coordinator
will complete Pre-Visit Planning reviews daily to improve HCC capture and HCC Persistency.

** Position is mostly Remote** occasional onsite work


Perform the payer audits as required under the Value Care contracts by performing validation of the providers and researching and responding to information requested by the payer.
Review the cases in the HCC Edit WQ to determine the HCC’s that need to be reordered in the top 12 diagnoses before releasing on the claim for billing.
Assist with creation and updating education tip sheets and tools for providers and other clinical and OP CDI staff such as the HCC/RAF Pocket Guide, HCC Coding Tip Sheets by clinical conditions, and relevant information in the Clinical Documentation Handbook.
Perform pre-visit medical record reviews patient’s upcoming clinic visit to identify conditions captured over the past 2 years that requires refreshing for the current calendar year. HCC conditions that impact HCC Persistency must be documented at least annually. The Risk Adjustment Coordinator creates queries/prompts to the provider according to the process defined and to facilitate appropriate clinical documentation to support the severity of illness, hierarchical condition categories, and complexity of care rendered to all patients.
Utilize the compliant query process according to guidelines, policy, and the AHIMA Standards of Practice. Communicate and collaborate with clinical and non-clinical staff to expedite the resolution of queries/prompts.
Utilize software systems such as the PCIC dashboard and reports, excel spreadsheets to ensure accurate data collection both pre-visit and post-visit for reporting KPI metrics and outcomes.
Demonstrate responsibility for professional growth and development by actively learning and participating in the continuing education offerings provided. Maintain competence in documentation requirements, coding guidelines, and quality measures.

Other Information

Other information:
Education Requirements:
● • High school diploma or GED required.
● • Successful completion of the OP CDI Proficiency Test.
Licensure/Certification Requirements:
● • Must have one of the following: - AHIMA (American Health Information Management Association) certification - AAPC (American Academy of Professional Coders) certification – CPC (Certified Professional Coder) or CRC (Certified Risk Coder) - ACDIS (Association of Clinical Documentation Improvement Specialists) certification - RN (Registered Nurse) license - LPN (Licensed Practical Nurse) license - Advance Practice Provider (NP or PA) license- Medical Doctor (MD) license
Professional Experience Requirements:
● • Minimum of twelve (12) months of OP coding experience or nursing experience in an ambulatory care setting
Knowledge/Skills/and Abilities Requirements:
● • Strong knowledge of medical record documentation requirements and coding guidelines in accordance with third party payer, state and federal regulations.
● • Strong ambulatory care clinical knowledge of clinical indicators, disease processes, and treatment.
● • Must possess strong communication skills, both written and verbal.
● • Exhibit effective organizational skills, time management, ability to be flexible, and management of multiple priorities.
● • Strong critical thinking and sound judgement in decision-making.

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: HIM CDI 

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care. This is not a State employed position.
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Diversity Statement

The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.

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