Risk Adjustment Coding Specialist (Remote)

We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

About the role

The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, HHS-Risk Adjustment Data Validation (RADV) audit and 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. This role includes developing and maintaining Commercial Risk Adjustment Coding guidelines, as well as guiding junior coding specialists.

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.
• Aims to achieve and maintain 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 the management team to further enhance quality and/or provider education.
• Collaborates with leadership and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines accepted by the federal government.
• Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions.
• Develops and maintains coding guidelines for Commercial Risk Adjustment, updating those guidelines for any changes in industry standards.
• Provides guidance and direction to Coding Specialists when reviewing complex medical records to help determine appropriate coding.
• Assists in guiding and mentoring less experienced staff; may lead a team of matrixed resources.

Requirements

• Associate's Degree in Health Information Technology, Business, or related field OR, in lieu of an Associate degree, an additional 2 years of relevant work experience is required.
• 3 years of risk adjustment/hierarchical condition category (HCC) coding experience.
• Must hold one of the following certifications upon hire: CCS (Certified Coding Specialist), CPC, CCS-P, or CRC. RHIT (Registered Health Information Technician) or RHIA preferred.

Skills

• Proficiency in Adobe Acrobat Professional, Microsoft Word, Excel, Outlook, and 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.
• Strong communication skills and ability to provide positive customer service to internal and external customers, including those who may be demanding or challenging.
• Ability to meet established deadlines and handle multiple customer service demands within set expectations for service excellence.

Travel

Approximately 5% travel required, including visits to medical sites to supervise medical record retrieval and attendance at conferences.

Pay

Salary range: $51,984 – $95,304. This range considers factors such as scope and responsibilities of the position, candidate’s work experience, education/training, internal peer equity, and market and business considerations. It is not typical for an individual to be hired at the top of the range.

Benefits

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