ACE Chart Reviewer

The ACE Chart Reviewer is responsible for performing thorough chart reviews and audits in order to inform providers of potential inferred, embedded, and missing diagnoses not previously identified and to aid in the education and discovery of opportunities for improved coding and documentation. The ACE Chart Reviewer will be responsible for educating others on appropriate documentation and coding, based on chart review findings. The ACE Chart Reviewer is licensed in the state of Pennsylvania, with knowledge of the ACE coding and documentation requirements and guidelines (training and certification provided by HCP).

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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.
  • Reviews and audits all charts that are assigned.
  • Reviews and audits all portions of the medical records including but not limited to past medical and surgical history, medication lists, specialty and primary care notes, imaging, hospital records, labs and vital signs.
  • Reviews and audits 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
  • Be accountable for regional improvement in ACE coding.
  • Recommends ongoing chart review process 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 coding and documentation.
  • 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 coding and documentation.
  • Uses, protects, and discloses Tandigm’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Performs additional duties as assigned

Education, Experience & Skills

Minimum

  • Bachelor’s Degree in Nursing required (8 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 Registered Nurse Licensure
  • 5 years of General Clinical experience required.
  • Two years of clinical coding claims review and utilization experience with strong attention to detail and a high level of accuracy
  • Knowledge of CMS-ACE/RAF model, coding, and guidelines along with ICD-9/10 and CPT guidelines
  • Knowledge of health plan and regulatory requirements.
  • Experience with at least one EMR and chart abstraction tools

Preferred

  • Additional Quality Assurance auditing experience
  • Additional Chart Review Experience

Essential Technical, Motor, and Interpersonal Skills/Other

  • Embraces and exemplifies core values of Tandigm Health.
  • Ability to anticipate and analyze factors.
  • Strong oral and written communication skills.
  • Possesses leadership qualities, such as:
  1. Ability to mentor, counsel, coach,  teach
  2. Ability to hold providers accountable & educate same on new methods and practices
  3. Ability to listen
  4. Able to resolve conflict
  5. Ability to accept input from others
  6. Ability to give clear direction and provide feedback
  7. Ability to accept coaching from others
  • Able to develop effective strategies for implementation of improved coding and documentation practices.
  • Possesses good verbal and written communication skills.
  • Values team members and a strong team player.
  • Possesses high ethical standards.
  • Ability to work independently.
  • Current and active Driver’s License
  • Access to a reliable vehicle and  Automobile Liability Insurance

Physical Requirements in Accordance with ADA

  • 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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