ACO Risk Coding Specialist (Hybrid)

Risk Coding Specialist

The risk coding specialist will assist providers in implementing coding guidelines and accurately documenting the disease burden of their patients. This role requires expertise in HCC-based risk adjustment, conducting medical chart reviews, designing workflows, and educating providers on proper documentation and coding guidelines.

• Identify and surface categories of diseases that matter, and understand the criteria for (a) surfacing, (b) proving, and (c) documenting a particular condition.
• Oversee an offshore team in conducting risk coding activities.
• Conduct chart reviews to identify suspect conditions and highlight inadequately coded progress notes.
• Design workflows to notify doctors of suspect conditions.
• Ensure incoming labs and diagnostic imaging results relevant to risk adjustment are brought to provider's attention.
• Provide education to providers on proper documentation and coding guidelines.
• Suggest improvements to team workflows to ensure maximum coding integrity.

Qualifications

• Strong working knowledge of CMS-HCC risk adjustment model (required for accurate coding and compliance).
• Solid understanding of ICD-10-CM coding guidelines.
• Experience identifying and coding chronic conditions requiring annual recapture.
• Ability to accurately identify and code chronic conditions such as CHF, CKD, COPD, and diabetes with complications.
• Experience reviewing face-to-face encounters and validating provider documentation.
• Experience with retrospective and/or prospective chart reviews.
• Experience with provider education or documentation improvement initiatives.
• Knowledge of hierarchical logic and exclusion rules in HCC coding.
• Strong analytical, organizational, and problem-solving skills, especially in Excel.
• Ability to research and resolve coding discrepancies independently.
• Effective written and verbal communication with clinical and non-clinical staff.
• Team-based orientation with ability to manage and report out KPIs.
• Cultural sensitivity and ability to work with diverse team members, both US-based and offshore, and with medical providers.
• Consistent ability to meet productivity and quality benchmarks.

Education

• High School Diploma or equivalent (required).
• International Medical Graduate (preferred).
• Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or CCS/RHIT/RHIA (AAPC or AHIMA).

Compensation & Benefits

• Pay: $27/hr base, some OT available, performance-based bonuses.
• Job Type: Full-time.
• Employer: Essen Health Care.
• Equal Opportunity Employer: Essen Health Care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.