Risk Adjustment Coding Specialist II

Department: Strategy and Operations
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

About the Role

Inpatient experience is a plus.

Responsibilities

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO), and Commercial risk adjustment documentation requirements are met, and deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company.
• Review medical record information on both a retrospective and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC).
• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines.
• Interact with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
• Meet or exceed productivity targets as established by management. Regularly meet due dates assigned.
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing.
• Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes. Stay informed about changes in Medicare, Medicaid, and private payer requirements.
• Keep management apprised of project activities through regular written and oral status reports. Proactively identify risks that may hinder project success.
• Provide recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Train, mentor, and support new employees during the orientation process. Function as a resource to existing staff for projects and daily work.
• Provide peer-to-peer guidance through informal discussion and overread assignments. Support coder training and orientation as requested by manager.
• May assist or lead projects and/or handle higher work volume than Risk Adjustment Coding Specialist I.

Requirements

• Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required.
• 3+ years experience in risk adjustment coding required. Billing experience is a plus.
• Reliable transportation, valid Driver’s License, and ability to travel at least 75% of work time.
• PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint.
• Excellent presentation, verbal, and written communication skills, and ability to collaborate.
• Ability to educate and train provider office staff members.
• Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.

Skills

• Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage.
• Ability to work independently and collaborate in a team setting.
• Strong organizational and time-management skills.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Provider Clinic service region for meetings and/or training as needed.
• Able to work independently and within time constraints.
• Able to efficiently prioritize multiple high-priority tasks.

Schedule

This position blends on-site fieldwork (approximately 75% travel) with hybrid support to help practices. The work arrangement may be modified, including transitioning to a hybrid or onsite model, based on business needs.

Pay

The national target pay range for this role is $75,000 - $85,000. Actual compensation will be determined based on geographic location, experience, and other job-related factors. The posted range for this role is $80,000 - $85,000 per year.