Risk Adjustment Specialist

Job Description

Job Description

Location: Birmingham, Alabama

Job Summary

The Risk Adjustment Specialist ensures all ICD-10 codes are documented for the assignment of valid and accurate HCCs for each record reviewed for submission to the Centers for Medicare & Medicaid Services (CMS). Other responsibilities include working suspect reports to identify unreported diagnosis codes and conducting chart audits on in-house records from other departments. This position will assist the Manager of Risk Adjustment with other projects as needed.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

See more about the benefits of working at Viva Health -

Key Responsibilities

• Maintain thorough understanding of the risk-adjusted payment methodology; what can be submitted by the plan and how/when submission impacts CMS payments.
• Demonstrate knowledge of ICD10 coding guidelines, medical terminology, disease processes, and pharmacology.
• Interpret and demonstrate analytical and problem-solving ability in reviewing medical record documentation to accurately assign ICD10 codes.
• Conduct chart reviews to identify all appropriate diagnoses based on CMS-HCCs and specific HEDIS measures.

REQUIRED QUALIFICATIONS :

• High School Diploma or GED
• At least 3-5 years' experience with coding
• Certified Coder (AHIMA or AAPC credentials)
• Read and interpret handwritten and typewritten material
• Excellent oral and written communications skills
• Ability to work under pressure to meet deadlines with minimal supervision
• Basic computer skills

PREFERRED QUALIFICATIONS:

• 2 or more years of college
• Experience with hospital coding