Risk Adjustment Coding Specialist verifying Medicare Advantage documentation for providers. Engaging with providers on coding requirements and conducting quality audits.
About the role
- Risk Adjustment Coding Specialist managing risk adjustment coding and billing for Medicare Advantage and ACA. Ensuring compliance with multiple healthcare coding standards and conducting provider education.
Responsibilities
- Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) 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
- 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
- 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
- Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
- Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
- Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
- Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
- May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
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
- Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time
- 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.
- You're great for this role if:
- • Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
- • Certified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experience
- • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
- • Strong PowerPoint and public speaking experience
- • Ability to work independently and collaborate in a team setting
- • Experience with Monday.com
- • Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting
Benefits
- The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
- This role follows a **hybrid **work structure where the expectation is to work on the field and at home on a weekly basis. This position requires **up to 75% travel** to provider offices in the surrounding areas in primarily **South Bay** area, but could also include Los **Angeles Metropolitan** Area and **Orange County**. The home office is located at 600 City Parkway West 10th Floor, Orange, CA 92868.
- The work hours are Monday through Friday, standard business hours.
- Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at **[email protected]**** **to request an accommodation.
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