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Chart Review Specialist- CPC-A, C or P required! Growing health Insurance!!

Company: Fallon Health
Location: Worcester
Posted on: March 13, 2018

Job Description:


* Perform retrospective chart reviews for designated populations & volumes

* Own chart review process from start to end

* Collect documentation feedback and submit to Nurse Chart Review Coordinator and Chart Review Coordinator for provider education efforts

* Update risk adjustment software with all relevant chart review observations

* Meet or exceed daily chart review targets


Develop and present concise provider-specific feedback for targeted providers and provider groups.

Identify diagnoses for submission as well as deletion in support of claims adjustment efforts * Ensure chart reviews and related claims adjustment activities completed within regulatory data submission timelines and within CMS Coding and Coding Clinic guidelines


Participate in corporate projects and subgroup meetings. Complete analyses related to corporate projects and business needs as needed.

Participate in regional Coding Chapter meetings


Education: High School diploma or GED required. Associated degree preferred.

Certification: CPC-A, CPC-C or CPC-P is required


* Completion of 135 Internship/Externship hours in the health care industry.

* Medical billing/claims processing ,medical record auditing, medical record review, Medical record abstraction or combination

* Medical terminology

* ICD-9 & ICD-10 compliant

* Basic MS Office skills; Excel and or Access

Fallon Health is an equal opportunity employer. It is very important for us to maintain a consistant hiring process for every candidate. In addition, we are also a government contractor with requirements to report on our Affirmative Action planning. To that end, we require everyone to apply online.

If you do not have access to a computer or need assistance completing the application process, please contact Human Resources at 1-508-368-9893 (TRS 711).

Keywords: Fallon Health, Worcester, Chart Review Specialist- CPC-A, C or P required! Growing health Insurance!!, Healthcare, Worcester, Massachusetts

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