We are looking for a Certified Risk Adjustment Coding Specialist who will work on site at our Alhambra office at 1668 South Garfield Avenue. This position will have the ability to work remotely some days and will also require frequent travel to provider sites dependent on projects. The shift will typically be M-F from 8am to 4:30pm.

SUMMARY

The Risk Adjustment Coding Specialist is responsible for reviewing provider documentation of diagnostic data from medical record to verify that all Medicare Advantage 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.

CORE RESPONSIBILITIES:

• Comply with department policies and procedures.
• Review medical record information on both a retroactive 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
• Assess adequacy of documentation and query providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
• ICD-10 CM code assignment by proficient analysis and translation of diagnostic statements, physicians' orders, and other pertinent documentation.
• Complies with all aspects of Coding, abides by all ethical standards, and adheres to official coding guidelines. Conducts physician chart audits to identify incorrect coding, prepares reports of findings and any compliance issues.
• Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing.
• Responsible for performing training and coordinating educational seminars for all risk adjustment
• Attend relevant trainings and technical content webinar training as required
• Reporting – generate and maintain accurate weekly/monthly/quarterly report of activities
• Attend to health plans, provider, and interdepartmental calls in accordance with exceptional customer service; maintain professional and appropriate behavior (actions/verbal) at all times
• Travel at least 75% of work time to visit providers
• Performs other duties, projects and actions as assigned in a professional manner, utilizing time and resources efficiently

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

REQUIRED QUALIFICATIONS:

• Minimum Education: High School diploma or Equivalent; BS/BA preferred

• Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Risk Adjustment Coder (CRC) & Certified Coding Specialist (CCS-P), CCS, CPC

• Minimum of two years’ experience in medical coding
• Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage. ACA's risk adjustment program is a plus.

• Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time.
• Must have an excellent understanding of medical terminology, disease process and anatomy and physiology. Ability to understands and explain data reports in different ways to practitioners
• Must have an excellent understanding of CPT/ICD-10 coding within a Primary Care environment

• Experience: ICD-10, Microsoft Power Point, CPT/HCPCS Coding, Medical Terminology, working knowledge of managed care and health plan standards on Risk Adjustment & HCC Coding
• Experience explaining coded data reports to practitioners and educating providers
• Flexibility, organization, and appropriate decision-making under challenging situations.
• Skill and experience in effectively collaborating with team members & others using oral, written, and interpersonal communications.
• PC skills and experience using Microsoft applications such as Word, Excel and Outlook
• Excellent analytical critical reasoning and interpersonal communication skill.

• Excellent presentation, verbal and written communication skills, and ability to collaborate with co-workers, senior leadership, and other management.
• Must be able to work independently utilizing all resources available while staying within the boundaries of duties.
• Must possess the ability to educate and train provider office staff members
• Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required.
• Must be ethical and possess the ability to remain impartial and objective.
• Should have strong communication and customer service skills and respect for confidentiality.

PREFERED QUALIFICATIONS:

• 
  Experience in data analytics and reporting
• Knowledge of practice management and/or financial aspects of the practice