Risk Adjustment Coding Specialist
2 weeks ago
Position Overview:
This role is pivotal in delivering comprehensive coding quality assessment services and scrutinizing clinical documentation for all healthcare providers within the USF Health organization.
The specialist will ensure timely communication regarding identified quality concerns related to documentation and coding, aiming for a minimum accuracy rate of 95%.
Key Responsibilities:
- Conduct audits of both retrospective and concurrent clinical documentation from medical providers, strictly following Medicare guidelines.
- Evaluate documentation to accurately assign and audit diagnosis codes.
- Identify opportunities for documentation enhancement and effectively communicate findings with healthcare providers and staff.
- Uphold professionalism by exercising sound judgment and ethical standards, fostering respectful working relationships throughout the organization.
- Exhibit integrity by adhering to high standards of personal and professional conduct.
- Comply with the Standards of Ethical Coding as established by the American Health Information Management Association and follow official coding guidelines.
- Possess knowledge of HIPAA regulations, demonstrating a commitment to the privacy, security, and confidentiality of all medical documentation.
- Maintain reliability and uphold a high level of confidentiality in all job-related activities.
- Hold relevant coding credentials such as CPC, COC, CCA, CCS, CRC, RHIA, or RHIT, with a minimum of two years of coding and auditing experience, including at least 12 months of HCC coding experience.
- Demonstrate advanced knowledge of ICD-10-CM and a working understanding of CPT and HCPCS coding systems.
- Exhibit a comprehensive understanding of CMS guidelines for risk adjustment and proficiency in HCC coding.
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