Senior Coder, Risk Adjustment

About the role

Prominence Health is a value-based care organization focused on bridging the gap between affiliated health systems and independent providers, fostering trust and collaboration. Founded in 1993, Prominence Health began as an HMO and was acquired by Universal Health Services, Inc. (UHS) in 2014. It serves members, physicians, and health systems across various payers including Medicare, Medicare Advantage, Accountable Care Organizations, and commercial partnerships. Prominence Health aims to transform healthcare delivery by improving outcomes and managing costs.

Responsibilities

• Document and code review of medical records at various partnered medical practices
• Ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement
• Work with assigned provider offices to maintain consistent and reliable methods of communication
• Occasionally work onsite at provider offices and may require travel for in-person provider education and training

Qualifications

• University/college degree or equivalent medical records, claims, or billing experience
• 3+ years in CMS coding and documentation guidelines, HCC risk adjustment coding practices
• CRC Required. Additional Coding certification preferred (CCS, CPC, RHIT)
• Must be credentialed through AAPC or AHIMA
• 2+ years in Risk Adjustment Coding
• Experience working in a variety of EMRs and the ability to navigate and pick up EMR applications
• Strong understanding and knowledge of CMS Coding and Documentation Guidelines
• Demonstrated competency in HCC coding practices
• Proficient with MS Office Suite (Word, Excel, Outlook), Internet, and databases
• Knowledge of age-specific needs and elements of disease processes and related procedures required
• Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes
• Previous medical office experience preferred
• Ability to read and write effectively in English; bi-lingual Spanish preferred
• Highly organized, proficient critical-thinking and analytical problem-solving skills
• May be required to be available beyond normal 8-5 working hours, including weekends, to accommodate office and provider hours
• Ability to work independently in a time-oriented environment is essential