Risk Adjustment Coding Specialist II

Risk Adjustment Coding Specialist II

Department: Strategy and Operations

Employment Type: Full Time

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Reporting To: Brian Ramos

Compensation: $75,000 - $85,000 / year

We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to the Supervisor - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects.

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
• Review medical record information on both a retrospective and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
• Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
• Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
• Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
• Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
• Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
• Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
• May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I

• Required Certification/Licensure:
  Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required
• 3+ years experience in risk adjustment coding required. Billing experience is a plus.
• 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 Power Point
• 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.

• 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…