ConcertoCare

Data Specialist

• Review and ensure the accuracy, completeness, and compliance of risk adjustment coding for internal claim submissions
• Conduct pre-claim, concurrent, prospective, and retrospective audits
• Maintain compliance with CMS Risk Adjustment Methodology rules and coding/documentation guidelines
• Monitor daily production volume and maintain a 95%–98% accuracy threshold
• Process standardized risk adjustment encounters according to cases-per-hour expectations
• Perform pre-claim audits and correct improper codes before claim submission
• Validate diagnoses against clinical documentation and MEAT criteria
• Ensure chronic conditions are actively managed during face-to-face visits
• Identify and remediate unsupported, suspect, or inaccurately coded conditions
• Identify trends, missed opportunities, and improvement areas through retrospective audits
• Monitor performance using accuracy trends, audit results, and turnaround times
• Collaborate with Clinical Documentation Improvement teams on provider education and documentation strategies
• Maintain adherence to internal compliance policies and external regulatory requirements
• Support internal, external, and health plan audit readiness, including RADV and plan audits
• Analyze audit trends and inform the CDI Manager about risk areas and improvement strategies
• Participate in risk adjustment strategy projects, prospective programs, and suspecting initiatives

Data Integrity Specialist, ICD-10

Social Worker

• Support the behavioral health needs of patients on an assigned caseload
• Deliver brief, evidence-based treatment for depression, anxiety, coping with loss, mood management, and substance-use disorders
• Support psychotropic medication management by collaborating with prescribing providers
• Support treatment adherence and monitor medication efficacy and potential negative side effects
• Coordinate with internal psychiatrists and clinical care teams on urgent psychotropic issues
• Participate in caseload reviews and clinical team meetings
• Facilitate communication regarding patients’ behavioral health needs
• Complete and document patient assessments in a timely manner
• Facilitate treatment plan changes using measurement-based care
• Serve as a behavioral health subject matter expert and share knowledge and resources
• Deliver care that honors patients’ diverse values, beliefs, backgrounds, and social, cultural, and linguistic needs
• Document patient encounters, referrals, and other pertinent information in the electronic health record
• Ensure encounter notes are locked according to company policy
• Perform other duties as assigned

Data Integrity Specialist, ICD-10

Social Worker – LCSW