Wilson clinical RN Coders  will drive consistent, efficient processes and share best practices in a collaborative effort with Providers and Market Team, designed to facilitate achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered.

The RN coder will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives.

Primary Responsibilities:

1. Develop and implement market business plans to motivate providers to engage in improving Risk Adjustment metrics
2. Provide logical interpretation of Risk Adjustment reporting including, Executive Summaries, HCC Ratio, Disagree and Resolution rates, and FaxBack reporting to plan and provider groups
3. Subject Matter Expert (SME) for all Risk Adjustment related activities within their assigned market(s) area.
4. Assist in developing of training and analytical materials for Risk Adjustment.
5. Lead Weekly, Monthly, Bi-monthly, Quarterly, and / or Annual Business Review meetings related to Risk Adjustment activities which summarize provider group performance and market performance as requested by or required by Market leadership
6. Analyze and evaluate provider group structure and characteristics, provider group / provider office operations and personnel to identify the most effective approaches and strategies related to Risk Adjustment
7. Develop solution-based, user friendly initiatives to support practice success
8. Oversee market specific chart retrieval and review of PCP, Hospital, and Specialist records

Wilson Clinical RN Coder Consultant will plan, conduct and coordinate all aspects of operational training related to HCC Coding/Documentation and Medicare Risk Adjustment.

The consultant will routinely consult with medical providers to clarify missing or inadequate information and to determine appropriate diagnostic coding. Wilson Clinical coder will serve as a subject matter expert and training resource related to Medicare Risk Adjustment.