Prisma Health
Greenville, SC, USA
Inspire health. Serve with compassion. Be the difference. Job Summary Conducts prospective review to abstract Hierarchical Condition Categories (HCC's) codes to report for the calendar year. Communicates (via Epic and in person) with providers on any outstanding HCC capture opportunities. Conducts retrospective reviews to ensure that documentation supports reporting the Hierarchical Condition Category code prior to payor submission. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Conducts prospective review of charts to identify HCC opportunity. Conducts retrospective review of charts to confirm documentation supports reporting. Utilizes payor specific software to assist in capturing HCCs. Communicates with providers about HCC opportunities for improvement. Identifies suspect conditions that would potentially support...