Accurate Coding & Education Chart Reviewer

The Accurate Coding and Education (ACE) Chart Reviewer is responsible for performing thorough chart reviews for our participating Primary Care Physician Practices to inform providers of potential inferred, embedded and/or missing diagnoses not previously identified and to aid in the education and discovery of opportunities for improved documentation and coding. The ACE Chart Reviewer will be responsible for educating others on appropriate documentation based on chart review findings. The ACE Chart Reviewer is a licensed Registered Nurse, Nurse Practitioner or Certified Physician Assistant (PA-C) in the state of Pennsylvania, with knowledge of documentation and coding requirements and guidelines.

Essential Functions

  • Consistently exhibits behavior and communication skills that demonstrate Tandigm’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
  • Obtains access and reviews all charts assigned, both remotely and on-site at Physician practices within the Chester, Montgomery, Bucks, Philadelphia, Delaware and Berks Counties.
  • Reviews all portions of the medical records including, but not limited to problem lists, past medical and surgical history, medication lists, specialty and primary care notes, imaging, hospital records, labs and vital signs.
  • Reviews all current and outstanding diagnoses for patients.
  • Documents newly found diagnoses and reports out to practices and internally.
  • Brings questions to the ACE Medical Director as needed.
  • Provides in-person debriefings to the practices and internally using all required reports including newly suggested chart review diagnoses.  Records debriefing comments/updates/feedback for ACE team.
  • Recommends ongoing chart review process improvements to ensure continued high standards in documentation and coding.
  • Undergoes continuous improvement training/meetings/education as directed by ACE team.
  • Attends and participates as requested in regional and corporate meetings that pertain to ACE documentation and coding.
  • Participates in the development, adoption and implementation process for ongoing ACE and documentation education for providers.
  • Attends courses as needed to improve knowledge of ACE documentation and coding.
  • Uses, protects, and discloses Tandigm’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Education & Experience

  • Bachelor’s Degree in Nursing or PA certification required (5 or more years of additional experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree);
  • Current, active, and unrestricted Pennsylvania (PA) Registered Nurse, Nurse Practioner or Physician Assistant licensure;
  • 5 years of General Clinical experience required with two years’ clinical chart or claims review experience, with strong attention to detail;
  • Knowledge of CMS Medicare Risk Adjustment Model;
  • Knowledge of health plan and regulatory requirements, coupled with strong technical skills including computer and software skills such as Microsoft Word, Excel, and Outlook;
  • One (1) year of EMR and chart abstraction tools.
  • Ability to travel at least 50% within the six county (Bucks, Montgomery, Delaware, Chester, Berks, and Philadelphia) region, & must have active/valid PA driver’s license.
  • Preferred: Additional Chart Review Experience

Physical Requirements

  • Carrying/Lifting: Occasional / 0-10 lbs
  • Standing: Constant / Up to 10 hours per day
  • Sitting: Occasional / Up to 3 hours per day
  • Walking: Constant / Up to 10 hours per day
  • Repetitive Motion: Keyboard activity, telephone use, writing
  • Visual Acuity: Ability to view computer monitor and read  newsprint with or without corrective lenses
  • Environmental Exposure: None
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