The Why Behind Wellvana: 

The healthcare system isn’t designed for health. We’re designed to change that.    

We’re Wellvana, and we help doctors deliver life-changing healthcare.  Through our high-touch approach to value-based care, we're moving beyond fee-for-service and helping tie the healthy outcomes of patients directly to healthier profitability for providers and health systems.  

Providers in our curated network keep their independence, reduce their administrative headaches, and spend more time with patients. Patients, in turn, get an elevated experience with coordinated care that is nothing short of life changing.    

Named a Best Place to Work by Nashville Business Journal and featured in Insider’s 33 startups “investors expect to take off in 2023,” we’re one of the fastest-growing companies in America because what we do works.

This is the way medicine is meant to be.

Clarity on the Role:

Wellvana is looking for a Certified Risk Adjustor to perform concurrent, prospective, and retrospective chart reviews and data validation in effort to properly educate physicians and ensure proper chart documentation. The HCC Coder will ensure the accuracy and completeness of patient medical records, which are essential for risk adjustment and determining appropriate reimbursement in value-based care models. Reporting to the Supervisor, Risk Adjustment Coding & Education, the primary focus will be on reviewing and validating electronic based medical charts to ensure accuracy of the HCC codes captured. 

What's Expected:

• HCC Coding: Identify and code Hierarchical Condition Categories (HCCs) based on documented conditions to ensure proper risk adjustment and reimbursement accuracy.
• Conduct prospective and retrospective chart review audits on outpatient medical chart notes to ensure the accuracy and completeness of documentation that reflects accurate coding selection per ICD-10 CM guidelines/reporting, which substantiates HCC codes captured and submitted to CMS for reimbursement.
• Review medical record information to identify and assess accurate coding based on CMS- HCC categories and abstract HCC data from provider chart notes if not captured or submitted via encounter/claim data submission during CMS sweep periods.
• Assist with concurrent chart review process and perform physician queries for coding and documentation clarification following physician query policy and procedure standards.
• Maintain a tracking and management tool for assigned medical record review projects.
• Meet and maintain productivity and accuracy metrics, as defined.
• Participate in Health Plan's RACCR audits, CMS Risk Adjustment Data Validation (RADV) audits.
• Medical Record Review: Review patient medical records, including physician notes, lab results, and diagnostic reports, to identify relevant diagnoses and capture essential information for accurate coding.
• Coding Expertise: Assign appropriate ICD-10 codes to document and accurately represent the patient's conditions and ensure compliance with coding guidelines and regulations.
• Collaboration: Work closely with healthcare providers, physicians, and other coding professionals to clarify documentation and ensure coding reflects the severity of illnesses and chronic conditions.
• Documentation Improvement: Provide feedback and education to healthcare providers regarding documentation deficiencies to improve accuracy and completeness.
• Quality Assurance: Perform regular audits to ensure compliance with coding guidelines and accuracy in documentation, and assist in resolving any discrepancies or issues found.
• Adherence to Regulations: Stay updated with changes in coding guidelines, regulations, and compliance standards to maintain accuracy and compliance within the coding process.
• Follow HIPAA protocol and comply with state and federal regulations.

 What’s Required:

• 2+ years of experience as an HCC/Risk Adjustment Medical Coding
• Certification as a Certified Risk Adjustment Coder (CRC) required
• High School diploma required, AA Degree or Bachelor’s degree preferred
• Strong understanding of ICD-10-CM coding guidelines, HCC coding methodologies, and risk adjustment models.
• Exceptional attention to detail and accuracy in coding and documentation review.
• Effective communication skills to collaborate with healthcare professionals and provide education on coding practices.
• Ability  to analyze medical records and extract pertinent information for coding purposes.
• Flexibility to adapt to changes in coding guidelines, technology, and healthcare regulations.
• Integrity: The right way is the only way. 
• Dependability: You do what you say you’re going to do. 
• Advocacy: You fight for the best possible outcome for providers and their patients. 
• Clarity: You make it all understandable.