Risk Adjustment Coordinator

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

📋 Description

• Assist the Director of Risk Coding and other team members in conducting pre- and post-visit review analyses for provider practices.

• Deliver risk coding education to healthcare providers to enhance practice risk scores.

• Professionally represent the department and health system while interacting with co-workers, hospital administrators, physicians, Medicare beneficiaries, and others.

• Collaborate closely with other departments to achieve positive outcomes.

• Conduct chart reviews and manage up-coding workflows.

• Oversee projects to ensure the successful achievement of goals within the CIN organization.

• Uphold the mission, vision, values, and strategic goals of Baptist South Florida.

⛳️ Requirements

• High School diploma, Certification, GED, Training, or Experience.

• Must have completed an accredited certified coding specialist program.

• AAPC Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), and/or Certified Professional Medical Auditor (CPMA) certifications are required.

• CPMA certification must be acquired within one year of hiring.

• Minimum of 2 years of experience in clinic or hospital settings and/or managed care environments.

• At least 1 year of experience in Risk Adjustment and HEDIS/Stars.

• Total minimum required experience: 5 years.

• Proficient in interpreting, analyzing, and abstracting data/documentation.

• Extensive knowledge of ICD-10-CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations, compliance, reimbursement, and risk-adjustment payment models.

• Capability to identify HCC improvement opportunities and to educate clinical providers on documentation, compliance, and coding guidelines.

• Intermediate proficiency in MS Office applications, including Excel, PowerPoint, and Word.

• Ability to defend coding decisions during both internal and external audits.

• Strong organizational skills with the ability to exercise judgment and initiative.

• Capacity to thrive in a continually evolving environment.

• Bachelor's degree in Science is preferred.

🏝️ Benefits

• Opportunities for career growth and development, with clear pathways and ongoing support.

• Comprehensive health and wellness resources available.

• A wellness program designed to assist employees in eliminating their medical plan deductible.

• Tuition reimbursement offered.