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Embedded Quality, Risk Adjustment And Medical Coding Specialist (Hybrid)
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- Acts as an internal population health expert to engage members to drive improvement in NCQA HEDIS measure performance.
- Utilizes extensive HEDIS and coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality outcomes and STARs outcomes while not compromising payment integrity.
- Conducts member outreach for appointment scheduling and collaborates with provider to ensure closure of quality and risk adjustment gaps in care.
- Supports and contributes to the development and refinement of effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality and STARs outcomes while not compromising payment integrity.
- Consults with various teams, including the Quality, Risk Adjustment, Practice Transformation Consultants, Medical Policy Analysts and Provider Networks colleagues to interpret coding and documentation language and respond to inquiries from providers.
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