About Us:

Health Fidelity delivers innovative solutions for the value-based care era. Using groundbreaking NLP and analytics technology, Health Fidelity’s risk adjustment solution is changing the way risk is identified, quantified and managed for organizations that participate in Medicare Advantage, ACA, Medicaid and Medicare ACO programs.

Our mission is to improve the quality of care and reduce the overall cost of healthcare by making the decision-making process more data driven. Our products will have an impact on the national healthcare infrastructure, as well as patients’ quality of life.

For more information about working at Health Fidelity, please visit our Careers Page

 About this job:

The Clinical Coding and NLP Analyst is a mid-level position who will help develop and enhance our proprietary world-class Natural Language Processing (NLP) engine that is underlying all our Risk-adjustment offerings. The Clinical Coding and NLP Analyst will have a background that combines clinical knowledge with a technical ability for data audits and QA. The Clinical Coding and NLP Analyst will work with our clients and internal teams to analyze and interpret medical record documentation and formulate appropriate suspecting and NLP rules to improve the completeness and accuracy of the NLP and suspecting logic. The Clinical Coding and NLP Analyst will possess the coding skills and sufficient experience to audit coders and the NLP by demonstrating mastery of the coding guidelines, coding clinics, clinical documentation and technical experience. 

 Responsibilities:

  • Be a clinical documentation/coding specialist to actively participate in selection process to drive continuous NLP/suspecting improvements.
  • Create evidence rules content supporting the correct ICD coding results for textual clinical documentation.
  • Create suspecting rules content supporting the correct ICD suspect, such as using clinical documentation, laboratory, pharmacy, claims, radiology and other clinical documents.
  • Report and track defects, assist developers in defect resolution.
  • Work with NLP Consultants and Engineering teams to define NLP and Suspecting rules, and articulate coding rules and conventions (rules for combined codes, inclusions, exclusions, etc.) in a meaningful way.
  • Write clinical / business rules to help our products more accurately identify diagnoses within medical records.
  • Perform coding quality assurance audits, ensure coders apply the appropriate coding/client guidelines and client SLA meet or exceeds 95% coding accuracy.
  • Supports all processes relating to HCC coding for new and existing clients.
  • Identify and create business rules for conditions where the NLP cannot solve.
  • Advise team members on clinical workflows, language, and documentation practices.
  • Assist in performing quality assurance tasks for the Product and Informatics releases.
  • Work closely with Informatics Engineers on analyzing data from our different clients.
  • Work closely with the Product Management team to utilize Informatics deliverables in the existing products and help enhance them.
  • Assist in performing quality assurance tasks for new and existing client organizations.
  • Knowledge of processes, NLP, clinical documentation and the ability to prepare and present information to internal and external customers.
  • Assists in meetings, training, and on-boarding for clients.
  • Other duties as assigned.

Requirements:

  • Bachelor's degree or equivalent experience. RN with coding/CDI skills /certification.
  • A medical coding certification (RHIA, RHIT, CCS, CPC) or Registered Nurse (RN) with at least 5 years of coding auditing experience.
  • 2+ years of Inpatient and/or Outpatient Clinical Documentation Improvement (CDI) experience.
  • 1+ year of clinical informatics experience preferred.
  • Clinical Informatics Certification optional.
  • Highly knowledgeable and experienced with ICD-10-CM/PCS and CPT-4 coding.
  • Expert knowledge of coding guidelines and coding updates; knowledge of Risk adjustment and HCC coding.
  • Experience in interpreting data sets and performing statistical analysis where needed.
  • Experience with SQL or the willingness to learn.
  • Experience in at least one Electronic Health Record (EHR) system (e.g.: Epic, Athena, Centricity, Cerner).
  • Experience in a healthcare IT environment.
  • Strong analytical; clinical thinking, troubleshooting and problem-solving skills.
  • Strong ability to work with cross-functional teams and be a team player.
  • Ability to work independently and in a fast-paced environment and do what it takes to get the job done.
  • Good written and verbal communications skills.  
  • Ability to organize and prioritize competing priorities. 
  • Willingness to travel <25%. .

Preferred:

  • Strong knowledge and understanding of standard clinical terminologies like SNOMED, RxNORM.
  • Experience with RADV or RAC audit and appeal processes.

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