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Risk Adjustment Coding Integrity Specialist

2 months ago

Denton, United States Choptank Community Health System, Inc.. Full time
Job DescriptionJob Description

Risk Adjustment Coding Integrity Specialist

Are you looking for meaningful, rewarding work that provides access to exceptional, comprehensive, and integrated health care for all. Join our growing team here at Choptank Community Health.

*Hybrid position with in office and remote work opportunity.

Job Summary: The Risk Adjustment Coding Integrity Specialist is a system support position that provides coding and abstracting of patient encounters. Works closely with physicians, team members, Quality, and Compliance to identify and deliver high quality and accurate risk adjustment coding. The Risk Adjustment Coding Integrity Specialist will demonstrate high-quality knowledge and understanding of ICD-10-CM, CPT, HCC, and HCPCS coding guidelines and practices for outpatient coding in an FQHC setting.

Required Skills/Abilities:

  • Communicate clearly and concisely, both oral and written.
  • Maintain effective working relationships with internal and external customers.
  • Must possess a valid drivers’ license and have dependable transportation.
  • Must be proficient with a computer and with Microsoft Office Suite.
  • Knowledge of practice management and electronic health record is essential.
  • knowledge and ability to distinguish the differences in coverage, charges, co-pays, denial codes, and denials reasons.
  • Understanding Federally Qualified Health Center or Rural Health Clinic reimbursement and billing preferred.
  • Must have the ability to calculate figures and amounts such as sliding fees, discounts, interest, proportions and percentages along with mathematical accuracy and attention to detail are essential skills for this position.

Education and Experience:

  • High school diploma or equivalent required.
  • Minimum of three years related experience and training in a medical office environment, preferably in a financial-medical setting, or a combination of education and experience in financial-medical setting.
  • Certified Professional Coding Certification required (AAPC), or related field of medical coding and documentation.

Standards of Behavior:

  • Commitment To Service
  • Respect
  • Quality
  • Teamwork
  • Patient Focus
  • Integrity
  • Accountability
  • Caring & Compassion
  • Professionalism
  • Listening & Responding
  • Safety
  • AIDET

Job Related Competencies:

  • Attention to Detail- The ability to process detailed information effectively and consistently.
  • Problem Solving- Identifies and analyzes problems weighing the relevance and accuracy of available information. Generates and evaluates alternative solutions and makes effective and timely decisions.
  • Communicates Effectively- Developing and delivering multi-mode communication that conveys a clear understanding of the unique needs of different audiences.
  • Values And Ethics- Serving with integrity and respect in personal and organizational practices. Ensuring decisions and transactions are transparent and fair.
  • Time Management- The ability to effectively manage one’s time and resources to ensure that work is completed efficiently.

Duties/Responsibilities:

  • 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. Acts as a coding resource across all departments. Utilizes knowledge of professional coding to review and recommend changes to ensure appropriate coding guidelines are maintained. Supports all risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories.
  • Analyzes medical records and identified documentation deficiencies. Reviews and verifies documentation that supports diagnoses, procedures and treatment results. Identifies diagnostic and procedural information.
  • Reviews code assignments and assigns modifiers when appropriate for clean claim filing. Queries providers as needed to ensure accuracy. Supports other key objective to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports and identifying process improvements.
  • Reviews medical documentation to ensure all key quality metrics are noted on claim, as provided during the encounter. Performs medical chart reviews to validate codes for quality monitoring, reporting, and analysis.
  • Works collaboratively with multiple departments, including but not limited to implementing and developing coding and documentation initiatives.
  • Reviews updated data and documentation standards and impact for Health Effectiveness Data Information Set (HEDIS) and Value Based incentives and other CCHS Quality Improvement initiatives.
  • Identifies discrepancies and billing issues. Researches, analyzes, recommends, and facilitates plan of action to correct discrepancies to prevent future coding errors.
  • staff of Works collaboratively with staff on billing and documentation requirements, coordinating and updating coding reference materials.
  • Upholds the Standards of Behavior and mission of Choptank Community Health System in a manner consistent with the core values of patient focused, respect, accountability, teamwork, continuous improvement, and integrity.
  • Attending regularly scheduled staff meetings.
  • Other duties as assigned.
  • Regular, reliable attendance is a requirement of this job.

Job Type: Full-time

Pay: Negotiable

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Employee assistance program
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Physical setting: Hybrid position with in office and remote work opportunity

Choptank Community Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital or family status, veteran status, sexual orientation, gender identity or expression, genetic information, political affiliation, arrest record, or any other characteristic protected by applicable federal, state, or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.