Risk Adjustment Coding Specialist
Mindlance, New York, NY, United States
Title: Risk Adjustment Coding Specialist
Duration: 3-4 Months (Possibility of extension)
Location: Remote
Purpose: The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, HHS-Risk Adjustment Data Validation (RADV) audit, and any other chart coding functions by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines. The development and ongoing maintenance of the Commercial Risk Adjustment Coding guidelines, as well as guiding junior coding specialists, are included in the job responsibilities.
ESSENTIAL FUNCTIONS: 45% Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity. Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review. Achieves and maintains coding accuracy levels greater than 90%. Works with vendors, providers and hospital staff to coordinate record access.
30% Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education. Work with leadership and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines which will be accepted by the federal government. Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions. Develop and maintain coding guidelines for Commercial Risk Adjustment, maintaining those guidelines for any changes in industry standards.
25% Provide guidance and direction to Coding Specialists when reviewing complex medical records to help guide in determining appropriate coding.
SUPERVISORY RESPONSIBILITY: Individual Contributor - Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.
SCOPE Freedom to Act Work is accomplished with limited direction. Determines and develops approach to solutions. Work is evaluated upon completion to ensure objectives have been met.
Problem Complexity and Problem Solving Timeframes Provides resolution to an assortment of problems that are typically well defined, but some clarification or judgment is required to determine action, as additional information about the problem / task is discovered. Uses judgment within defined practices / procedures to determine appropriate action. Problem/Task resolution timeframe: Inclusive of shorter timeframes, but the majority of tasks take up to several weeks to resolve.
Level of Supervision Received Plans and arranges own work, refers only unusual cases to supervisors or others.
Impact Failure to achieve results or erroneous judgments may require the allocation of additional resources to correct and / or achieve goals.
Contact with Others Frequently inter-organizational and outside customer / vendor contacts. Part of a team who represents the organization. Monitors activities and communicates information across the organization
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: Associate's Degree
Education Details: Health Information Technology, Business or related field
Experience: 3 years risk adjustment/hierarchical condition category (HCC) coding experience
In Lieu of Education In lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience.
Preferred Qualifications : Knowledge, Skills and Abilities (KSAs) Adobe Acrobat Professional, Advanced Microsoft Word, Excel, Outlook, Claims Processing? Facets., Advanced Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms., Advanced Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging., Advanced The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Licenses/Certifications : CCS-Certified Coding Specialist or CPS, CCS-P, CRC Upon Hire Req or RHIT - Registered Health Information Technician or RHIA Upon Hire Pref
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
Purpose: The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, HHS-Risk Adjustment Data Validation (RADV) audit, and any other chart coding functions by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines. The development and ongoing maintenance of the Commercial Risk Adjustment Coding guidelines, as well as guiding junior coding specialists, are included in the job responsibilities.
ESSENTIAL FUNCTIONS: 45% Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity. Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review. Achieves and maintains coding accuracy levels greater than 90%. Works with vendors, providers and hospital staff to coordinate record access.
30% Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education. Work with leadership and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines which will be accepted by the federal government. Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions. Develop and maintain coding guidelines for Commercial Risk Adjustment, maintaining those guidelines for any changes in industry standards.
25% Provide guidance and direction to Coding Specialists when reviewing complex medical records to help guide in determining appropriate coding.
SUPERVISORY RESPONSIBILITY: Individual Contributor - Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.
SCOPE Freedom to Act Work is accomplished with limited direction. Determines and develops approach to solutions. Work is evaluated upon completion to ensure objectives have been met.
Problem Complexity and Problem Solving Timeframes Provides resolution to an assortment of problems that are typically well defined, but some clarification or judgment is required to determine action, as additional information about the problem / task is discovered. Uses judgment within defined practices / procedures to determine appropriate action. Problem/Task resolution timeframe: Inclusive of shorter timeframes, but the majority of tasks take up to several weeks to resolve.
Level of Supervision Received Plans and arranges own work, refers only unusual cases to supervisors or others.
Impact Failure to achieve results or erroneous judgments may require the allocation of additional resources to correct and / or achieve goals.
Contact with Others Frequently inter-organizational and outside customer / vendor contacts. Part of a team who represents the organization. Monitors activities and communicates information across the organization
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: Associate's Degree
Education Details: Health Information Technology, Business or related field
Experience: 3 years risk adjustment/hierarchical condition category (HCC) coding experience
In Lieu of Education In lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience.
Preferred Qualifications : Knowledge, Skills and Abilities (KSAs) Adobe Acrobat Professional, Advanced Microsoft Word, Excel, Outlook, Claims Processing? Facets., Advanced Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms., Advanced Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging., Advanced The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Licenses/Certifications : CCS-Certified Coding Specialist or CPS, CCS-P, CRC Upon Hire Req or RHIT - Registered Health Information Technician or RHIA Upon Hire Pref
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.