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Job Details

Coding Compliance Specialist - (HEDIS)

Requisition #: 291986
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Nov. 3, 2020

Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.

Position Summary

Uses coding expertise to ensure appropriate codes are set up by specialty and/or plan. Monitors annual code changes implemented by CMS and Ingenics, using these data sources to determine annual rates for JHHC plans and providers. Assists HEDIS Manager and Clinical staff with specific elements of the EMR Standard Supplemental Data Process and performs data abstraction and documentation from medical records as appropriate.

The HEDIS Coding Compliance Specialist is responsible for assisting the HEDIS Manager and Clinical Quality Management Nursing Staff with specific elements of the EMR Standard Supplemental Data Process and performs data abstraction and documentation from medical records as appropriate. This includes the annual project and prospective review process. This role is a critical support to HEDIS efforts to ensure that JHHC meets and exceeds benchmarks as prescribed by the National Committee for Quality Assurance (NCQA) and the Centers for Medicare and Medicaid (CMS). HEDIS is a critical function that comprises a large number of points needed for NCQA accreditation. HEDIS is also critical to the Maryland Department of Health Value Based Purchasing (VBP) measures as well as CMS Star ratings.

A. Education:

Requires an AA degree in Business, Health Care Administration or relation field, Bachelor’s degree preferred. Professional experience in advanced medical record documentation and at least 10 years of progressive medical record coding and auditing experience. CPC or AAPC Certification is required.

B. Knowledge

Requires strong familiarity with healthcare managed care processes and terminology. Requires a comprehensive and expert understanding of claims processes with advanced knowledge of physician billing and coding regulations related to CPT/ICD-9 coding. Must be familiar with reimbursement methodologies and guidelines. Knowledge of healthcare regulatory requirements, medical plans and the ability to effectively communicate (oral and written).

C. Skills:

Must be self-motivated and able to work independently to assess situations and respond appropriately, make independent decisions and the ability to accept change. Requires strong analytical and problem solving skills to assess, prioritize and solve complex problems. Excellent interpersonal and oral and written skills to effectively interact with all levels of the company, vendors and consultants. Ability to balance multiple tasks, simultaneously and quickly switch between priorities/tasks. Ability to interact with all levels of staff and adapt to a rapidly changing work environment.

D. Required Licensure, Certification, Etc.:

Requires certification as a coding specialist

E. Work Experience

Professional experience in interpreting medical record documentation and at least 5 years of progressive medical claims or related insurance experience with a minimum of 1 year coding and/or auditing experience.

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.


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