Risk Adjustment Coding Accuracy Specialist

Position Summary

Responsible for implementation of initiatives to improve documentation and coding accuracy for Lumeris clients. Regularly reviews provider medical records for accurate and complete documentation and coding.

Job Description

• Reviews medical records in support or pre-visit planning and post-visit program for opportunities with complete and accurate documentation and coding
• Identifies chronic conditions for providers to review during patient visits
• Queries providers to ensure complete and accurate documentation and coding after patient visits
• PARTNERS WITH PROVIDERS AND CLINICAL/ADMINISTRATIVE STAFF TO ENHANCE UNDERSTANDING OF CLINICAL DOCUMENTATION IMPROVEMENT PROGRAM GOALS IN ORDER TO ACHIEVE RISK ADJUSTMENT STRATEGIC GOALS AND INITIATIVES
• Maintains current subject matter expertise by attending professional meetings, seminars, and related continuing education events
• Collaborates with internal teams to assure client/project-specific goals are met
• Reviews project specific documentation and code specificity for validation
• SUPPORTS IN OVERSIGHT (OVERREADS) OF CODING VENDOR
• RESPONSIBLE FOR COMMUNICATION, INPUT AND FINDINGS TO SUPPORT SENIOR AUDITORS

Qualifications

• Bachelor's degree or equivalent
• 3+ years of ICD-10 outpatient coding and provider query experience or the knowledge, skills, and abilities to succeed in the role
• Strong knowledge of ICD-10-CM Coding Guidelines, E/M, CPT/HCPCS, CMS-HCC risk adjustment model, medical record review project management, encounter data management, and IPM/RADV
• Demonstrated ability to work cross-functionally within corporate matrix environments
• Effective ability to collaborate and partner on complicated initiatives
• Favorable computer skills (i.e. Microsoft Office)

Preferred

• Associate degree or technical school
• CPC-I or CRC Certifications

Working Conditions

While performing the duties of this job, the employee works in normal office working conditions

Pay Transparency

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

Hiring Range

The hiring range for this position is: $54,800.00-$73,250.00

Benefits

• Medical, Vision and Dental Plans
• Tax-Advantage Savings Accounts (FSA & HSA)
• Life Insurance and Disability Insurance
• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
• Employee Assistance Program
• 401k with company match
• Employee Resource Groups
• Employee Discount Program
• Learning and Development Opportunities
• And much more...

Be part of a team that is changing healthcare!

Member Facing Position

No - Not Member or Patient Facing Position

Drug Screen Requirement

Location: United States

Time Type: Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Disclaimer

The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities. Lumeris is an EEO/AA employer M/F/V/D.