About us:
Fallon Health is a company that cares. We prioritize our membersalwaysmaking sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nations top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programsincluding Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly) in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Responsibilities:The Chart Review Specialist primary responsibility is to review, analyze and report on FCHP patient charts for the purpose of validating regulatory Risk Adjustment scores. The Chart Review Specialist will collect diagnostic details and documentation observations from multiple chart sources to validate diagnostic profiles. The CRS must demonstrate the ability to oversee the chart review life cycle from scheduling access, collecting images, coding chart and updating data software. The CRS must have the ability to code on both and INP and OPD basis. Will participate in monthly Inter-rater reliability discussions to develop and enforce coding P&Ps and define Coding Standards and best practices. Accept assignment from the Manager. Maintain strong interdepartmental relationships. Light travel may be required.
Chart Review ~85%
Regulatory Complianc e ~10%
Corporate Project Support ~5%
License/Certifications: CPC-A, CRC, CPC-C or CPC-P is required
Education: High School diploma or GED required. Associated degree preferred.
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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