Risk Adjustment Coding Specialist

Title: Risk Adjustment Coding Specialist

Location: Administrative Office - Patient Accounts Department

City: Bellingham, WA

Position: Full time 40 hours, Monday-Friday 8:00am-5:00pm, non-exempt (hourly)

Compensation: The full wage scale is $25.75 - $35.42 per hour. Placement within the range is determined by an evaluation of the candidate’s background, education, and experience.

Benefits: At FCN, we offer a comprehensive benefits package designed to support your well-being and that of your family, with flexibility and quality care.

Health Benefits:

• Three Medical plan options
• Two Dental plans, including orthodontia for children and adults
• Employer-paid Vision coverage for employee and family
• Expanded Employee Assistance Program (EAP) and mental health programs, including wellness and discounted gym memberships
• Flexible Spending Account (FSA), Healthcare and Dependent Care
• Health Savings Account (HSA) with an employer contribution of $1,500 (pro-rated based on enrollment eligibility)
• Health Reimbursement Account (HRA), up to $1,500 ($3,000 for family coverage)
• Employer-paid Life/AD&D insurance with optional supplemental additional coverage including a guaranteed issue amount with no health questionnaire
• Voluntary Accident and Hospital insurance plans with annual wellness benefits

*Eligibility for these benefits depends on your full-time or part-time status.

Time Off & Wellness:

• Paid Time Off (PTO), Paid Sick Leave (PSL), and Extended Illness Bank (EIB) to support your vacation, health, and personal needs
• PTO, PSL, and EIB accrue starting on your first day, and you can use paid time off after the applicable days of employment
• Full-time employees generally begin earning 18 days of PTO, increasing 33 days over time per our PTO policy.  You can rollover unlimited PTO hours into the next year.
• PSL accrues at 1 hour per 40 hours worked
• EIB accrues up to 32 hours per year (pro-rated based on hours worked) for both part-time and full-time employees, with a maximum of 480 hours

Retirement:

• 401(k) plan with employer match, both Traditional and Roth options available
• 401(k) Profit Sharing Plan
• Free financial planning guidance to support your retirement goals

*Eligibility for these programs is based on your years of service and required hours.

Additional Benefits:

• Eligibility for FCN applicable bonuses

Job Summary: Primary responsibility is to assess Risk Adjustment / HCC coding practices for Family Care Network Practitioners and billing staff ensuring that regulations are being followed

We are looking for a qualified, motivated individual who can:

• Review medical record information to identify, collect, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC).
• Audit provider documentation of CPT and ICD-10 codes to ensure adherence with coding and CMS Risk Adjustment guidelines.
• Evaluate HCC audit processes and provide analysis and recommendations to improve overall provider documentation and coding.
• Responsible for ongoing provider education on HCC.
• Support and participate in process and quality improvement initiatives.
• Meet productivity and quality standards.
• Review Comprehensive Health Assessment forms.
• Performs other duties, as required.

Essential Knowledge, Skills and Abilities:

• Extensive experience with healthcare coding and billing processes.
• Knowledge of Medicare managed care.
• Familiarity with EMR software.
• Extensive knowledge of CPT and ICD Codes.
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
• Must be able to achieve and maintain an accuracy standard of 95% or better.
• Intermediate computer skills: Word, Excel and Outlook.
• Commitment to discern and maintain confidentiality, in compliance with applicable State & Federal laws (i.e., HIPAA).
• Strong experience solving problems and addressing concerns in a collaborative manner; knowing when to request support from a supervisor.
• Ability to work both independently and as part of a team.
• Actively support and promote positive work and team ethic.
• Proven internal and external customer service skills.
• Proven ability to prioritize and multi-task detailed projects despite frequent interruptions.
• Proven ability to understand and communicate information accurately and clearly verbally and in writing, in person and over the telephone.

About FCN: As an independent, locally owned, physician-run network of family medicine providers, we are passionate about our community's well-being. We take the time to build strong, long-term relationships with our patients and our employees. We have 12 clinics and 3 urgent care centers in Whatcom and Skagit County, in a beautiful corner of northwest Washington where the mountains meet the sea. Family Care Network offers an innovative and rewarding work environment, with a strong patient focus and a fulfilling mission.

Education & Experience:

• High School Diploma, GED or equivalent knowledge and skills obtained through a combination of education, training, and experience.
• Two or more years of medical office experience required
• Five or more years of biller/coder experience required
• Certified Medical Coder with CPC and one or more of the following required:
  • CRC
  • Minimum of two years HCC coding experience required
  • Ability to obtain CRC within 1 year

Physical Requirements: While performing the duties of this job, the employee is required to stand, walk, sit, use hand-to-finger coordination, handle or feel objects, tools or controls, reach with hands and arms, climb stairs, balance, stoop, kneel, crouch, and listen attentively. The employee must occasionally lift and/or move up to 30 pounds.

Immunization Requirements: Employees are required to meet immunization standards in accordance with federal, state, and organizational health and safety guidelines, as applicable to the role. A simple process is in place for employees to request exemptions for medical or religious reasons.

Family Care Network is a Drug-Free, Equal Opportunity Employer

Salary : $26 - $35