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Risk Adjustment Coding Specialist

ICONMA

Key Facts

Remote From: 
Virginia (USA)
Full time
Mid-level (2-5 years)
English

Other Skills

  • •
    Microsoft Excel
  • •
    Quality Assurance
  • •
    Microsoft Word
  • •
    Microsoft Outlook
  • •
    Non-Verbal Communication
  • •
    Adaptability
  • •
    Time Management
  • •
    Teamwork
  • •
    Customer Service
  • •
    Prioritization
  • •
    Social Skills
  • •
    Problem Solving

Roles & Responsibilities

  • Associate's Degree in Health Information Technology, Business, or related field (or 2 additional years of relevant work experience in lieu of degree)
  • 3 years of risk adjustment / HCC coding experience
  • CCS-Certified Coding Specialist or CCS-P, CRC (upon hire) and RHIT or RHIA (preferred upon hire)
  • Strong expertise in ICD-10-CM coding, especially for Commercial Risk Adjustment, and ability to interpret moderately to complex medical records

Requirements:

  • Supports retrospective risk adjustment filing, HHS-Risk Adjustment Data Validation (RADV) audits, and other chart coding functions by performing moderately complex medical record review and coding; ensures compliance with applicable laws and documentation guidelines; develops and maintains Commercial Risk Adjustment coding guidelines and mentors junior coding specialists
  • Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation at all levels of complexity; utilizes coding guidelines and recommends changes to diagnosis codes; maintains coding accuracy above 90%; coordinates record access with vendors, providers, and hospital staff
  • Identifies and documents coding observations or discrepancies; provides information to management to enhance quality and provider education; negotiates complex diagnoses with leadership and third-party vendors; develops and conducts new physician/practitioner coding orientation/education; maintains coding guidelines for Commercial Risk Adjustment
  • Provides guidance and direction to Coding Specialists when reviewing complex medical records; serves as a mentor; may lead a team of matrixed resources and plans own work with limited direction

Job description


Our Client, a Health Insurance company, is looking for a Risk Adjustment Coding Specialist for their Remote location.
 
Responsibilities:
  • The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, HHS-Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines. The development and ongoing maintenance of the Commercial Risk Adjustment Coding guidelines, as well as, guiding junior coding specialists are included in the job responsibilities.
  • 45% Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity. Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review. Achieves and maintains coding accuracy levels greater than 90%. Works with vendors, providers and hospital staff to coordinate record access.
  • 30% Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education. Work with leadership and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines which will be accepted by the federal government. Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions. Develop and maintain coding guidelines for Commercial Risk Adjustment, maintaining those guidelines for any changes in industry standards.
  • 25% Provide guidance and direction to Coding Specialists when reviewing complex medical records to help guide in determining appropriate coding.
  • Individual Contributor - Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.
  • Work is accomplished with limited direction. Determines and develops approach to solutions. Work is evaluated upon completion to ensure objectives have been met.
  • Provides resolution to an assortment of problems that are typically well defined, but some clarification or judgment is required to determine action, as additional information about the problem / task is discovered. Uses judgment within defined practices / procedures to determine appropriate action. Problem/Task resolution timeframe: Inclusive of shorter timeframes, but the majority of tasks take up to several weeks to resolve.
  • Plans and arranges own work, refers only unusual cases to supervisors or others.
  • Failure to achieve results or erroneous judgments may require the allocation of additional resources to correct and / or achieve goals.
  • Frequently inter-organizational and outside customer / vendor contacts. Part of a team who represents the organization. Monitors activities and communicates information across the organization
 
Requirements:
  • Associate's Degree
  • Education Details: Health Information Technology, Business or related field
  • 3 years risk adjustment/hierarchical condition category (HCC) coding experience
  • In lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience.
  • Adobe Acrobat Professional., Advanced
  • Microsoft Word, Excel, Outlook, Claims Processing ? Facets., Advanced
  • Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms., Advanced
  • Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging., Advanced
  • The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Client programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
  • CCS-Certified Coding Specialist or CPS, CCS-P, CRC Upon Hire Req or
  • RHIT - Registered Health Information Technician or RHIA Upon Hire Pref
  • Strong expertise in ICD-10-CM coding, especially for Commercial Risk Adjustment
  • Ability to interpret moderately complex to complex medical records
  • Deep understanding of CMS, HHS, RADV, and risk adjustment coding and documentation guidelines
  • Strong written and verbal communication skills
  • CRC required
 
Why Should You Apply?  
ICONMA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to any status protected by applicable law.
 
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