Welcome to Pathways Health Partners, the Accountable Care Organization (ACO) that's leading the charge in helping independent providers transition to Value-Based Care.

What We Do:

Medicare

REACH ACO

We're at the forefront of Medicare innovation.

Medicare Advantage MSO:

Providing top-notch services to our Medicare Advantage patients.

Commercial MSO:

Managing care for approximately 16,000 patients across North-West/Central Florida.

Where We Operate:

From The Villages to St. Petersburg, and across to Mount Dora, we've got you covered!

Our Services:

Hospital Medicine Group:

Delivering exceptional care in hospitals.

Affiliated Medical Practices:

Managing several top-tier medical practices.

Insurance Agency:

Offering comprehensive insurance solutions. Join us on our journey to better health and value-based care! Job Summary The HCC Risk Coder plays a vital role in coordinating and supporting retrospective and concurrent chart reviews while providing education and facilitating chart retrieval for Health Plan audits and reports. This position requires a comprehensive understanding of Hierarchical Condition Categories (HCC) coding to accurately translate, input, extract, and validate medical record data.

Position Responsibilities:

Review and assess documentation to accurately translate chronic conditions into the appropriate diagnosis codes from outpatient medical records. Extract data for Health Plan reports and input data collected from HCC programs. Assist in obtaining medical records from Providers to support audits requested by Health Plans. Help coordinate training sessions for Physicians and staff on relevant coding guidelines and compliance standards. Review provider documentation to verify that HCC codes are accurate and meet required documentation guidelines. Assign appropriate

ICD-10-CM

codes that map to risk adjustment models and identify documentation discrepancies, querying providers for clarity when necessary. Participate in clinical documentation improvement initiatives and maintain regular attendance at team meetings. Handle special projects as assigned and perform other duties as needed. Qualifications and Education Requirements High School Diploma or GED. An active CRC (certified risk adjustment coder) or CPC (certified professional coder) preferred. 2. Understanding of regulations regarding medical coding and documentation; Administrative responsibilities, professional written and verbal communication, typing skills. 3. Documented training in Medicare Risk Adjustment (MRA), HCC coding documentation guidelines, rules, and regulation. 4. Two years demonstrated experience in amedicalorhealth planenvironment 5. Excellent computer skills with experience in Outlook, MS Office, MS Excel, MS Word Pathways Health Partners is a growing company based in Leesburg, FL. We are proud of our professional yet family culture with the executive team working daily alongside our team members. We provide competitive salaries and a benefits package that ...