It’s Time For A Change...
Your Future Evolves Here
Evolent Care Partners’ works directly with primary care organizations across the country to improve patient outcomes and reduce avoidable health care costs. We are a lean, nimble, and fast-paced team looking for innovators and disruptors with a passion for improving health care. Our team is made up of reliable, hard-working employees—each with a commitment to shaping our culture and strategy. This role presents a unique opportunity to get in on the ground floor of an internal start-up and leave your mark on health care.
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. We bring our whole selves to work, and we’re driven to make a difference every day, from the work we do in our roles to the charitable endeavors we support. We believe in starting by listening, communicating with candor, fostering inclusion, and owning the opportunity. We respect and celebrate individual talents and team wins. Whether we’re wearing scrubs, jeans, or our finest work-from-home chic, we have fun, work hard, and make time to help others.
Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving diversity, equity, and inclusion (DE&I) efforts. Evolent achieved a 100% score on the 2020 Human Rights Campaign's Corporate Equality Index, making us one of the best places to work for LGBTQ+ employees. We were also named on the Best Companies for Women to Advance List 2020 by Parity.org and we publish an annual Diversity Report to share our progress on how we’re building an equitable workplace and performing on various metrics. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Who You’ll Be Working With:
Under the direction of the Senior Director, Risk Adjustment Coding Strategy, you’ll collaborate with other ECP team members, leaders and Providers as needed. This role is an intricate part of the Risk Adjustment coding team and ECP programs. The goal is to support ECP’s coding strategy, tactics, and data capture processes to drive overall optimal Risk Adjustment coding performance.
What You Will Be Doing:
ECP’s Risk Adjustment Coding Support Specialist will perform a comprehensive review of each Progress Note and will ensure the clinical documentation in the Progress Note supports the ICD-10 codes assigned to the claim to the highest level of specificity before submission. Compliance with Official Coding Guidelines in ICD-10-CM coding conventions, as well as CMS Risk Adjustment Data Validation (RADV) guidelines, is a must. The focus of this position is to confirm accuracy and specificity of diagnoses codes assigned on the claim are in accordance with the AHA ICD-10-CM coding guidelines, CMS clinical documentation guidelines, and RADV criteria.
This position may require communicating with the provider to obtain higher specificity for accuracy of code assignment. Clinical knowledge and high-level analytical skills are utilized in the review of each Progress Note to confirm support of appropriate ICD-10-CM code assignment for accuracy of risk score assignment and reimbursement. This role is specific to provider clinical documentation and the requirements of CMS for RADV and reporting.
Accurate coding with demonstration of knowledge in the principals and practices of ICD-10-CM and CPT conventions applies continuously. You must enjoy reading and demonstrate the ability to put clinical pieces of documentation together for diagnosis coding specificity, validation, and accuracy. Maintaining a high level of proficiency, productivity and accuracy with awareness and understanding of CMS RADV HCC compliance and guidelines will have you thriving in this position. Awareness, alertness, and the ability to understand the continuous changing guidelines and requirements for physician documentation and ICD-10-CM coding with excellent communication skills to mitigate risk to ECP is priority.
Primary Responsibilities:
With use of the current programs, EMR, tools and resources, r e vi e w ICD-10-CM diagnosis codes submitted on claims in conjunction with the clinical documentation in the Progress Note f o r ac c u racy of ICD-10-CM coding assignment to the highest l e v el of specificity i n a t i m e l y and ef f i c i e n t m a nn er, maintaining productivity and accuracy:
The Experience You’ll Need (Required):
Finishing Touches (Preferred):
Technical requirements:
Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. Evolent Health maintains a drug-free workplace.
APPLYAbout Evolent Health
Evolent Health is a population health management services organization (MSO) that integrates the technology, tools and on-the-ground resources to support health systems in executing on their population health and care transformation objectives.
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