Risk Adjustment Coding Specialist II

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate provider documentation and diagnostic data from medical records to confirm compliance with Medicare Advantage, Affordable Care Act (ACO), and Commercial risk adjustment documentation standards.

• Provide both individual and group educational sessions to providers within managed IPAs.

• Analyze medical records retrospectively and prospectively to identify, assess, monitor, and document claims and encounter coding data relevant to HCCs.

• Conduct code abstraction and coding quality audits to ensure precise ICD-10-CM coding and adequate clinical documentation support.

• Engage with physicians concerning coding, billing, documentation policies, procedures, and any unclear documentation.

• Prepare and execute auditing analyses, offering feedback on any identified instances of noncompliance.

• Stay updated on coding regulations, compliance guidelines, ICD-10 and HCC updates, and payer requirements.

• Suggest process enhancements, perform root-cause analysis, and resolve barriers related to Risk Adjustment initiatives.

• Train, mentor, and assist new hires throughout their orientation period.

• Provide peer-to-peer support, informal discussions, and oversee assignments.

• Assist with or lead projects, as well as handle increased workloads compared to Risk Adjustment Coding Specialist I.

• Attend department and provider meetings with video on.

• Carry out other assigned responsibilities.

⛳️ Requirements

• AAPC certification (CPC) is mandatory and must be maintained.

• CRC certification is preferred.

• A minimum of 3 years of experience in risk adjustment coding and/or billing is required.

• At least 1 year of experience in targeted provider education is essential.

• Reliable transportation and a valid driver’s license are necessary.

• Ability to travel up to 75% of work time is required.

• Proficient in PC skills and experienced with Microsoft Word, Excel, and Outlook.

• Outstanding presentation, verbal, and written communication abilities are a must.

• Strong collaborative skills are essential.

• Capability to educate and train provider office staff members is required.

• Familiarity with healthcare coding software and Electronic Health Records (EHR) systems is necessary.

• Solid billing knowledge and/or Certified Professional Biller (CPB) certification through AAPC is advantageous.

• Understanding of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage is crucial.

• Strong experience in PowerPoint and public speaking is expected.

• Ability to work independently while also collaborating effectively in a team environment is important.

• Experience using Monday.com is preferred.

• Experience in collaborating with, educating, and presenting to provider teams in face-to-face settings is beneficial.

🏝️ Benefits

• Remote position available within the U.S.

• Opportunity for quarterly travel to provider offices located in Houston.

• Equal Employment Opportunity and Affirmative Action employer.

• Application accommodations are available for candidates with disabilities.