Risk Adjustment Coding Specialist II
$70,000–$85,000 year
HybridCalifornia, United States or Orange, California, United States
Job Summary
Review provider documentation to verify Medicare Advantage, ACA, and Commercial risk adjustment requirements while delivering education to provider staff. Assess medical records retroactively and prospectively to identify, monitor, and document claims coding for Hierarchical Condition Categories (HCC). Perform code abstraction and quality audits to ensure ICD-10-CM accuracy and adherence to CMS guidelines, then prepare analysis on noncompliance issues. Interact with physicians regarding coding policies and conflicting documentation, while maintaining current knowledge of evolving coding regulations and payer requirements. Provide recommendations for process improvements and root-cause analysis, and mentor new employees through orientation and overread assignments. This role requires 75% travel to provider sites and reports to a Sr. Manager - Risk Adjustment.
Required Qualifications
- Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC)
- 3+ years experience in risk adjustment coding and/or billing experience
- Reliable transportation/Valid Driver's License
- Must be able to travel at least 75% of work time
- PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint
- Excellent presentation, verbal and written communication skills, and ability to collaborate
- Must possess the ability to educate and train provider office staff members
- Proficiency with healthcare coding software and Electronic Health Records (EHR) systems
Desired Qualifications
- Certified Risk Adjustment Coder (CRC)
- Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
- Ability to work independently and collaborate in a team setting
- Strong organizational and time-management skills
- Ability to work in a home office for continuous periods of time for business continuity
- Able to travel across the Provider Clinic service region for meetings and/or training as needed
- Able to work independently and within time constraints
- Able to efficiently prioritize multiple high-priority tasks
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