Risk Adjustment Coder

4 days ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. Colorado Community Managed Care Network provided pay range This range is provided by Colorado Community Managed Care Network. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $53,000.00/yr - $70,000.00/yr Direct message the job poster from Colorado Community Managed Care Network Director of Human Resources and Business Operations Description Applicants will must apply through this link to be considered. Responsibilities: The Value Based Coding Advisor will interact with operational and clinical leadership to assist in the identification of Risk Adjustment/HCC coding opportunities, and will provide targeted education to CHC providers, billers, coders, and support staff to support value-based contract initiatives. Risk Adjustment/HCC Coding Support and Education Educates providers and staff on coding regulations and changes as they pertain to risk adjustment and quality reporting to ensure compliance with federal and state regulations. Assist the department, direct supervisor and CHPA in the development of education tools related to risk adjustment/HCC coding and gap closure. Supports the creation of education that will train CHC providers, billers, coders, and support staff, as well as CHPA staff, for risk adjustment/HCC coding opportunities. Maintains a database with the results of all medical chart reviews performed, with ability to report on progress and statistics on coding initiatives. Pre-Visit Planning (PVP) Performs weekly Pre-Visit Planning reviews for assigned CHC’s and will query providers or other identified team member to further value-based contract initiatives including coding recommendations based on internal and external medical records, review of payer portals and suspected conditions, and review of care gap and clinical documentation. CHC Support Holds monthly meetings with identified coding champions, provide education and training to CHC providers, billers, coders, and support staff in proper coding guidelines; and documentation education based on PVP observations and monthly topics. Provides monthly chart reviews of randomly selected patients and providers participating in Pre-Visit Planning (PVP) program to give feedback on missed opportunities and errors. Gap Closure Success Reviews patient charts to identify areas for quality gap closures and provide compliant documentation to appropriate payers resulting in gap closures for assigned CHC’s. Ensures that providers understand CPT II coding for the purposes of quality gap closure and reporting. CCMCN Success Assist in all CCMCN dashboard and scorecard initiatives to improve performance outcomes. Assist supervisor in implementing best practices, policies, and procedures to increase support services to the CHCs we serve Assist in developing and sharing guidelines/best practices with internal risk adjustment coders to help improve coding documentation techniques for our members Helps with special projects within Risk Adjustment Department Requirements To achieve high-quality outcomes the Value Based Coding Advisor is to have knowledge of HEDIS/STARs measures and guidelines, CMS Hierarchical Condition Category (HCC) coding guidelines, clinical documentation standards, and education/training skills. High School diploma or equivalent. Minimum 2 years coding experience The American Academy of Professional Coders (AAPC) Certified Risk Adjustment Coder (CRC) certification is required; Certified Professional Coder (CPC) Certification will be considered with Risk Adjustment/HCC Coding experience and willingness to obtain CRC within 1 year of employment Risk Adjustment experience required. FQHC billing experience is highly preferred Experience with clinic billing and coding required Knowledge of several EHR systems preferred (ECW, Athena, Greenway Intergy, Epic). Clinical background preferred Strong knowledge of CMS coding and quality guidelines. Strong knowledge of PowerPoint, excel and Microsoft word with the ability to manipulate basic information and data required for preparing reports and delivering training. Exceptional interpersonal, public speaking, and presentation skills to deliver training and education is preferred. Ability to facilitate group discussions that challenge participants and promote discussion of new approaches and solutions based on data and value-based care initiatives. Ability to adapt to changing initiatives and priorities based on the needs of CCMCN and the CHC’s success. Ability to professionally communicate and manage conflict with others in both an internal and external setting. Ability to work independently and to self-motivate to complete tasks; resourceful and proactive. Fluency in written and spoken English, with reading comprehension skills. Displays cultural competence in diversity, equality, equity, and inclusion to fit CHPA’s cultural values and mission. Ability to travel to and within the state of Colorado- 25% travel within the state of Colorado with an unrestricted driver’s license and an insured vehicle. In-state, Colorado residents preferred. Proof of full COVID- 19 vaccination may be required for employment. Home office that is HIPPA compliant and has high speed internet capability. Mobile device for work purposes. Working Environment and Physical Activities Hybrid position- work from home with 25% travel capability. This position requires several hours of travel to meetings in the state of Colorado. Insured group health, dental, & vison plans (NOTE: Medical Insurance may not be available for out of state employees) Medical and dependent care flexible spending account options 401k retirement plan with an employer contribution match Life, AD&D, and Long-term disability plans paid for by employer Free 24/7 access to confidential resources through an Employee Assistance Program (EAP) Voluntary benefit plans to complement health care coverage including accident insurance, critical illness, and short-term disability A generous mix of vacation, sick and holiday paid days off CCMCN is an equal opportunity employer with a policy that provides equal employment opportunity for applicants and employees regardless of race, color, religion, disability, gender, age, national origin, sexual orientation, gender identity, marital status, pregnancy, veteran status, or any other classification protected by law. This policy applies to all aspects of employment, including recruitment, hiring, promotion, compensation, reassignment, layoff, discharge, education, training, and all other working conditions. Seniority level Seniority level Entry level Employment type Employment type Full-time Job function Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Colorado Community Managed Care Network by 2x Sign in to set job alerts for “Medical Coder” roles. Facility Coding Outpatient Complex Coder We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr