Risk Adjustment Coding Specialist (Hybrid)

About the role

The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, HHS-Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines.

Responsibilities

• Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity.
• Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review.
• Achieves and maintains coding accuracy levels greater than 90%.
• Works with vendors, providers and hospital staff to coordinate record access.
• Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education.
• Work with leadership and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines which will be accepted by the federal government.
• Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions.
• Develop and maintain coding guidelines for Commercial Risk Adjustment, maintaining those guidelines for any changes in industry standards.
• Provide guidance and direction to Coding Specialists when reviewing complex medical records to help guide in determining appropriate coding.

Requirements

• Education Level: Associate degree in Health Information Technology, Business or related field OR in lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience.
• Experience: 3 years risk adjustment/hierarchical condition category (HCC) coding experience.
• Licenses/Certifications: CCS-Certified Coding Specialist or CPC, CCS-P, CRC Upon Hire RequiredRHIT - Registered Health Information Technician or RHIA Upon Hire Preferred

Qualifications

• Adobe Acrobat Professional.
• Microsoft Word, Excel, Outlook, Claims Processing, Facets.
• Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Skills and Abilities (KSAs)

• Knowledge of Federal, State and/or County laws and regulations related to coding and documentation guidelines.
• Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms.
• Effective communication and providing positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Benefits

We offer a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Pay

Salary Range: $51,984 - $95,304

Schedule

Estimate Amount: 5% medical sites to supervise medical record retrieval, conferences