Job Description:
JOB SUMMARY/PURPOSE
Develops, implements, and maintains auditing practices related to medical record coding and documentation to enhance risk adjustment outcomes for Medicare members. Ensures member medical records comply with CMS's Risk Adjustment Data Validation procedures. Responsible for ensuring risk score accuracy, identifying and communicating coding and documentation quality trends, and developing provider intervention strategies.
DEPARTMENT DESCRIPTION
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.
EXPERIENCE/EDUCATION/QUALIFICATIONS
Bachelor s Degree or equivalent experience required.
Current RHIA, RHIT or CPC Certified Coder through AAPC and/or AHIMA required.
Certified Risk Adjustment Coder (CRC) preferred.
Two (2) years coding experience with at least one (1) year of specialized experience with the CMS-HCC (Hierarchical Condition Category) model required.
Experience with computer applications, including MS Office (Excel, Word, PowerPoint) required.
Experience with Epic workflows preferred.
Experience working in NLP coding platform preferred.
Must have experience with health plans.
Position Urgency:
Normal
Shifts:
Days, no weekends
State License Details:
Not Needed
Minimum Years of Experience:
2
Minimum Guaranteed Hours:
40
Specialty Type:
Medical Coding
Sub Specialty:
Outpatient Coder
Bilingual:
No
EMR Used:
EPIC
Holiday Coverage Required:
No