Experienced ambulance billing coder for a Michigan EMS provider responsible for accurate insurance claim inputs and coding according to CMS guidelines.
About the role
- Risk Adjustment Coding Specialist supporting risk adjustment efforts through chart reviews and provider education. Estimated travel up to 75% in Inland Empire region, specifically LA or Orange County.
Responsibilities
- Conduct high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers.
- Translate findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations.
- Track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
- Interact 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.
- Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes.
- Provide recommendations related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
- Train and mentor new employees during the orientation process.
Requirements
- Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Coding Specialist (CCS-P), CCS, or CPC.
- 3-5+ years of experience in risk adjustment coding and/or billing experience required.
- Strong billing knowledge and/or Certified Professional Biller (CPB) through AAPC.
- Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time, if applicable.
- PC skills and experience using Microsoft applications such as Word, Excel, and Outlook.
- Excellent presentation, verbal and written communication skills, and ability to collaborate.
- Must possess the ability to educate and train provider office staff members.
- Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.
Benefits
- The national target pay range for this role is $75,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
- Hybrid work structure with expectation to work on the field and at home on a weekly basis.
- Up to 75% travel to provider offices is required.
- Work hours are Monday through Friday, 830 AM - 5 PM.
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