Risk Adjustment Coding Specialist - Remote / Telecommute

Job Title

Pay Range: $31.03hr - $36.03hr

Requirement/Must Have

• Associates degree in Health Information Technology, Business, or a related field.
• Instead of an Associates degree, an additional 2 years of relevant work experience is required in addition to the required work experience.
• 3 years of risk adjustment and/or hierarchical condition category coding experience.
• Strong knowledge of diagnosis code validation, coding guidelines, and documentation standards.
• Ability to verify the accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation.
• Ability to identify coding discrepancies and recommend updates based on chart review.
• Ability to maintain coding accuracy levels greater than 90 percent.
• Strong communication and collaboration skills when working with vendors, providers, hospital staff, and internal leadership.
• Ability to work independently with limited direction and exercise sound judgment.
• Ability to mentor and guide less experienced coding specialists.

Experience

• Experience supporting retrospective risk adjustment supplemental filing.
• Experience supporting HHS-Risk Adjustment Data Validation audit activities.
• Experience reviewing and coding moderately complex medical records.
• Experience working with vendors, providers, and hospital staff to coordinate record access.
• Experience identifying coding discrepancies and supporting quality and provider education initiatives.
• Experience negotiating agreement on complex medical record diagnoses with leadership and third-party vendors.
• Experience developing and conducting coding orientation and education for physicians or other healthcare practitioners.
• Experience developing and maintaining Commercial Risk Adjustment coding guidelines.
• Experience guiding junior coding specialists on complex chart reviews.

Responsibilities

• Perform medical record review and coding for retrospective risk adjustment supplemental filing, HHS-Risk Adjustment Data Validation audit support, and other chart coding functions.
• Verify the accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation.
• Apply appropriate coding guidelines and recommend changes to diagnosis codes based on chart review findings.
• Achieve and maintain coding accuracy levels greater than 90 percent.
• Coordinate with vendors, providers, and hospital staff to obtain and manage record access.
• Identify and document coding observations or discrepancies.
• Provide findings and recommendations to management to enhance quality and provider education.
• Work with leadership and third-party vendors to resolve complex medical record diagnosis questions and determine compliance with coding guidelines accepted by the federal government.
• Develop and conduct coding orientation and education sessions for physicians and other healthcare practitioners.
• Develop and maintain Commercial Risk Adjustment coding guidelines and update them based on changes in industry standards.
• Provide guidance and direction to Coding Specialists when reviewing complex medical records.
• Assist in mentoring less experienced staff and may lead matrixed resources as needed.
• Plan and manage work independently, escalating only unusual cases when necessary.

Should Have

• Experience working in a highly regulated healthcare environment.
• Strong analytical and problem-solving skills.
• Ability to adapt to changing coding standards and industry requirements.
• Ability to manage multiple tasks that may take from short-term turnaround to several weeks to resolve.
• Strong customer service skills with internal and external stakeholders.

Skills

• Risk adjustment coding.
• HCC coding.
• Medical record review.
• Diagnosis code validation.
• Chart review.
• Coding compliance.
• Coding discrepancy identification.
• Provider education.
• Coding guideline development and maintenance.
• Audit support.
• Mentoring and guidance.
• Adobe Acrobat Professional.
• Microsoft Word.
• Microsoft Excel.
• Microsoft Outlook.
• Claims processing systems.
• EMR systems.
• EHR systems.
• Coding documentation platforms.
• Customer service and communication.