Risk Adjustment Coding Specialist-Provider Coding

Position Summary

Under the direction of the LHRPG Coding Manager, the Risk Adjustment Coder is responsible for encursing proper risk adjustment coding by performing coding audits of physicians and Advanced Practice Providers. Ensures accurate representation of the care provided and ensures accuracy in the HCC codes reported. This role assists in improvement in the overall completeness and accuracy of quality data and outcomes through extensive interaction with physicians, nursing and administrative staff. Ensures the appropriate clinical diagnosis and procedure codes are assigned in accordance with the appropriate level of service provided with nationally recognized coding guidelines. The coder provides coding expertise as well as administrative oversight to ensure successful integration of initiatives. Performs chart documentation audits, educates providers and staff on current coding practices and assures that all compliance standards are met.

Active - Benefit Eligible and Accrues Time Off

Work Hours per Biweekly Pay Period: 80.00

Shift: Monday - Friday

Location: Remote

Pay Range: $29.21 - $36.51

Education Required: High School Diploma or GED

Experience Essential:

10 years of coding experience in professional/ambulatory coding setting or acute care hospital outpatient coding experience, 3 years’ experience with medical office health care reimbursement and compliance. Knowledge of ICD-10, CPT and of HCC (Hierarchical Condition Categories).

Experience Preferred: Management/supervisory/coordinator experience in healthcare related field preferred.

Certification Essential: CPC, CCS-P, or CCS with two or more additional AAPC Specialty Medical Coding Certifications. Must have CRC (Certified Risk Adjustment Coder)

Position Responsibilities

People At The Heart Of All That We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

People At The Heart Of All We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
• Safety And Performance Improvement
• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.
• Stewardship
• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

Standard Work: LRHPG Risk Adjustment Coding Specialist

• Serves as subject matter expert for ambulatory professional coding; proactively identifying issues or trends and reporting to the LRHPG Coding Manager, as appropriate.
• Reviews and analyzes medical information from medical records against health assessment documents to ensure accurate coding of diagnostic and procedural information in accordance with national coding guidelines.
• Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes.
• Maintains current knowledge of all HEDIS, HCC and related coding measures using all available and relevant government and insurance resources.
• Evaluate the quality and consistency of medical record review and write a well-reasoned finding’s rational for each provider letter, with a professional writing manner.
• Prepare reports of findings and share with Managers and assist the Managers in providing feedback and remediation to reviewers.
• Conducts ongoing chart audits and prepares reports with action plans needed to address compliance issues associated with reimbursement policies and procedures.
• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
• Identifies and summarizes findings for internal and external parties to help providers improve their documentation and coding. Educates, trains, and provides assistance in a variety of ways to help providers and clinic staff close gaps in diagnoses and treatment opportunities.
• Assists healthcare providers and clinics in identifying and resolving issues related to incomplete or missing chart documentation, ambiguous or nonspecific documentation or codes that do not conform to regulatory guidelines.

Competencies & Skills

Essential:

• Computer experience, especially in spreadsheet analysis and word processing (e.e.g Microsoft Word and Excel). Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
• Ability to learn new computer applications quickly and independently and become a skilled user of the organization's technology. Demonstrated familiarity with a variety of practice management software including EHR(s).
• Excellent knowledge of anatomy and physiology, pathophysiology, disease processes, pharmacology, and medical terminology. Excellent knowledge in ICD-10-CM, CPT, HCPCS, modifier assignment, OCE and CCI edits and medical necessity.
• Requires critical thinking skills, organizational skills, written and verbal communication skills, decisive judgment, and the ability to work with minimal supervision.
• Demonstrates adaptability and self-motivation by staying abreast of CMS rules and regulations and incorporating those changes into daily practice.