Risk Adjustment Coding Specialist II - Houston
$70,000–$85,000 year
HybridHouston, Texas, United States
Job Summary
Conduct high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy in Medicare Advantage, ACA, and Commercial risk adjustment. Translate findings into actionable insights by delivering education to providers and practice leaders while navigating complex conversations. Perform code abstraction and quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation per CMS guidelines. Review medical records retroactively and prospectively to assess claims and encounter coding information related to Hierarchical Condition Categories (HCC). Interact with physicians regarding coding policies, procedures, and conflicting documentation, while preparing analysis and providing feedback on noncompliance issues. Maintain current knowledge of coding regulations, compliance guidelines, and updates to ICD-10 and HCC codes. Provide recommendations to management on process improvements, root-cause analysis, and barrier resolution applicable to Risk Adjustment initiatives.
Required Qualifications
- Must possess and maintain AAPC certification, CPC and CRC
- At least 3 years of experience in risk adjustment coding and/or billing experience required
- At least 1 year of experience with targeted provider education
- Reliable transportation/Valid Driver's License/Must be able to travel up to 75% of work time
- PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
- 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
- Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
- Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
- Strong PowerPoint and public speaking experience
- Ability to work independently and collaborate in a team setting
- Experience with Monday.com
- Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting
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