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Define Ventures Partners

Clinical Documentation Coder and Educator

UpStream Care

UpStream Care

Software Engineering
Posted on Friday, June 7, 2024

At UpStream, we are dedicated to promoting good health and empowering individuals to lead independent lives. As a trusted partner to primary care physicians, we offer effective and sustainable care options, focusing on seniors and those with chronic conditions. Our comprehensive solution allows physicians to prioritize patient care while our value-based care model ensures effective condition management.

We prioritize affordability and accessibility, collaborating with healthcare practices and clinics to reduce costs and enhance system efficiency. Through personalized care plans and innovative solutions, we strive to improve health outcomes and enable patients to live fulfilling, independent lives.

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.

At UpStream we offer a range of benefits to ensure our employees are taken care of. Our health insurance plans through United Health Care include FSA and HSA options, and we also offer dental, vision, life, and accident coverage through Guardian. We immediately match contributions to our 401k plan, which includes both Roth and Traditional options. In addition, we provide financial perks and rewards through BenefitHub, and free access to EAP services through WorkLifeMatters. Our employees also enjoy generous PTO and paid holidays.

We value diversity and promote equal opportunities for all. As an equal opportunity employer, we do not discriminate against applicants based on their race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. All qualified candidates are encouraged to apply.