Risk Adjustment Coding Specialist
Job in
Greensboro, Guilford County, North Carolina, 27497, USA
Listing for:
Care N Care Insurance Company of North Carolina
Full Time
position
Listed on 2026-01-12
Job specializations:
-
Healthcare
Medical Billing and Coding, Healthcare Administration, Medical Records, Healthcare Compliance
Salary/Wage Range or Industry Benchmark: 60000 - 80000 USD Yearly
USD
60000.00
80000.00
YEAR
Job Description & How to Apply Below
JOB SUMMARY
The Risk Adjustment Coding Specialist supports Health Team Advantage's mission to improve the health and well-being of our communities by committing to personalized service, quality, and enhanced care experiences, while maintaining our core values of integrity, quality, service, people, and patient safety.
The Risk Adjustment Coding Specialist will perform and support risk adjustment activities in accordance with both the Centers for Medicare and Medicaid (CMS) rules and regulations and the American Hospital Association (AHA) documentation guidelines for the proper ICD-10-CM code assignment.
In addition, the Risk Adjustment Coding Specialist will perform prospective and retrospective chart reviews of both inpatient and outpatient services to capture compliant Hierarchical Condition Categories (HCC). The Risk Adjustment Coding Specialist will also be responsible for record retrieval, Risk Adjustment Data Validation (RADV) audits, and all other Risk Adjustment Compliance activities. The Risk Adjustment Coding Specialist will partner and assist with the Risk Adjustment Nurse Coding Specialist and the Risk Adjustment Coding and Documentation Specialist as needed.
ESSENTIAL DUTIES AND RESPONSIBILITIES This position must be able to: ****
Medical Record Review:
Conduct and/or assist with prospective/retrospective medical record review audits evaluating medical record documentation to ensure hierarchical condition category (HCC) coding is accurately supported/captured by Health Team Advantage through review of coding, medical record documentation, and billed claims.Responsible for the manual chart retrieval process for internal coding activities, such as but not limited to internal audits, assisting with vendor retrieval, HEDIS chart chase, and RADV.Collaborate with Provider Services when needed to assist with record retrieval.Vendor Coding Review:
Perform vendor quality oversight audits by auditing a sample of targeted charts to ensure coding quality in accordance with the vendor’s contract.Assist with tracking coding vendor audit results.Assist with the dispute/rebuttal process for diagnosis code discrepancies.RADV:
Perform Record Retrieval for internal Mock – RADV, CMS Improper Payment Measurement (IPM) activities, etc.Collaborate with Provider Services when needed to assist with record retrieval.Review the medical records to identify the one best supportive record for the HCC/diagnosis code targeted by CMS.During Mock RADV and IPM audits, collaborate with the Risk Adjustment team for second-level review of the record(s) chosen to submit to CMS.During Contract RADV audits, collaborate with the Vendor and the Risk Adjustment team to review charts selected for RADV submission.Assist/perform the submission of chart notes to CDAT in accordance to CMS’s regulations.Other Coding
Activities:Ensure regulatory compliance and overall quality and efficiency by utilizing a strong working knowledge of coding standards, anatomy, physiology, pathological processes of disease, and medical terminology.Follows ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinics, along with CMS guidance and regulations.Accurately and efficiently review medical records to abstract diagnoses for proper ICD-10-CM and/or hierarchical condition category (HCC) code assignment to the highest level of specificity as supported by documentation.Maintains confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.Serve as subject matter expert on risk adjustment diagnosis coding guidelines.Abide by ethical coding standards as set forth by the American Health Information Management Association (AHIMA) and/or the American Academy of Professional Coders (AAPC).Other Duties as AssignedEDUCATION AND EXPERIENCE
Education:- High School Diploma or GED
- Coding Certification: CPC, RHIT, CCS, or CCS-P
Required Experience:- 1+ year(s) of HCC coding experience.
- 1+ year(s) of previous experience with paper and/or electronic medical records required.
- Must have a thorough understanding of ICD-10-CM Official Coding Guidelines and AHA Coding Clinics
Preferred Experience:
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