Medical Risk Adjustment Coding Specialist

Under the direction of the Value Based Care Program Manager, the medical risk adjustment coder provides administrative and clinical support for the Quality, Population Health, and other programs. The medical risk adjustment coding specialist will play an essential role in the billing and value-based care process. Utilizing a strong knowledge of anatomy, pathophysiology, and medical procedures, the medical risk adjustment coder will provide a direct bridge of understanding between payers and providers. The Medical Risk adjustment coding specialist must abide by various regulatory compliance rules and must always treat patients with dignity and respect. Must meet and maintain department and individualized productivity and efficiency standards. Will successfully complete all required annual training and pass all competencies. Will ensure appropriate systems, policies and procedures are in place to drive quality clinical outcomes, patient/staff satisfaction and excellent financial performance. Collaborates with FHCN administration and physicians to develop and implement the Agency strategic plan, measures performance, and develops and implements improvements.

ESSENTIAL DUTIES AND RESPONSIBILITIES (Included but not limited to the following).

• Oversee the organization’s hierarchical condition category (HCC) coding.
• Identify Value Based Program requirements and educate staff on program guidelines.
• Work collaboratively with the Quality Department to complete Risk Adjustment data validation.
• Review and assign accurate CPT, HCPCS, CPTII ADA, and ICD-10 codes for diagnoses, procedures, and evaluation and management services performed by physicians and other qualified healthcare providers.
• Perform regular retrospective documentation and coding reviews for all FRHC departments to ensure that providers are adhering to documentation and coding guidelines.
• Document all coding changes made appropriately within the eCW system and notify the provider via the eCW messaging system.
• Serve as an organization wide resource for all coding related inquiries.
• Process all assigned charge sessions and review all claims for services rendered to ensure proper billing for reimbursement of services.
• Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Researches and analyzes data needs for reimbursement.
• Analyzes medical records and identifies documentation deficiencies.
• Serves as resource and subject matter expert to other coding staff.
• Reviews and verifies documentation that supports diagnoses, procedures, and treatment results.
• Identifies diagnostic and procedural information.
• Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Assigns codes for reimbursements, research and compliance with regulatory requirements utilizing guidelines.
• Identifies discrepancies, potential quality of care, and billing issues.
• Researches, analyzes, recommends, and facilities plans of action to correct discrepancies and prevent future coding errors.
• Identifies reportable elements, complications, and other procedures.
• Assists in orienting, training, and mentoring staff.
• Provides ongoing training to staff as needed.
• Handles special projects as requested.
• Enhances operational effectiveness, emphasizing cost containment without jeopardizing innovation, or quality of care.
• Maintains compliance with Medicare, HIPAA, OSHA, and Labor Laws.
• Ensures ongoing commitment to excellent customer service.
• Completes required continuous training and education, including department specific requirements.
• Ensure the integrity of EMR by providing quarterly chart audits.
• All other duties as assigned.
• Demonstrated success in program implementation, operations, and fiscal management.

EDUCATION and/or EXPERIENCE:

• High School Diploma required.
• Associate degree or higher preferred.
• Medical terminology knowledge preferred.
• Electronic medical records experience strongly preferred.
• Some exposure to billing/data analysis.
• Valid Drivers' License.
• Experience in a Federally Qualified Health Center strongly preferred.

LICENSURE:

• CPC, CRC CPC-P, or CCS-P required.

PHYSICAL DEMANDS

• Required to be able to type proficiently, write legibly and to read printed or handwritten materials.
• Needs to be able to communicate and respond effectively.
• Occasionally may need to crouch, kneel, stoop or bend.
• May need to assist with moving or lifting >30 pounds.
• Requires visual acuity to perform tasks requiring close vision and ability to adjust focus.
• Required to be able to travel to meetings outside the organization's facility, including some out-of-town travel.
• Required to be able to work evenings and weekends if needed.

WORKING CONDITIONS

• Administrative Office Setting Monday through Friday.
• Exposure to communicable diseases, blood, and other bodily fluids.
• May attend meetings, seminars and speaking engagements locally and out of state.

TRAVEL REQUIREMENTS:

• Some travel between locations required.