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Risk Adjustment Coding Specialist

2 months ago

Orlando, Florida, United States Wellvana Integration Partners, LLC Full time

About Wellvana:

At Wellvana, we are committed to transforming the healthcare landscape. Our mission is to enable healthcare providers to deliver exceptional care that prioritizes patient outcomes over volume.

Our innovative value-based care programs are designed to overhaul a system that has historically favored quantity over quality. By aligning patient health outcomes with the financial success of primary care providers, we are creating a more sustainable healthcare model.

Our network of providers enjoys the freedom to operate independently while minimizing administrative burdens, allowing them to focus on what truly matters—patient care. Patients benefit from a comprehensive care experience that is coordinated and available around the clock.

Position Overview:

The Risk Adjustment Coding Educator plays a vital role in guiding healthcare providers through the complexities of risk adjustment coding, regulatory standards, and accurate documentation practices for various patient populations. This role involves analyzing coding trends and documentation patterns to tailor educational initiatives effectively.

The ideal candidate will possess a deep understanding of risk adjustment coding principles and the HCC Risk Adjustment Model Categorical Hierarchy, with the ability to convey this knowledge clearly to healthcare providers. Responsibilities include conducting follow-up education sessions, tracking coding improvements, and distributing necessary training materials.

Key Responsibilities:

  • Provide education to healthcare providers on the significance of risk adjustment, including CMS-HCC coding guidelines, documentation practices, and the identification of unreported conditions.
  • Conduct training on Prospective, Retrospective, and Concurrent review processes.
  • Establish and nurture professional relationships with providers and their teams, ensuring regular face-to-face interactions.
  • Disseminate educational resources and coding tools, guiding providers in utilizing technology to uncover potential missed conditions.
  • Collaborate with various teams, including Practice Transformation Specialists and Audit teams, to enhance provider-specific education.
  • Analyze documentation and coding errors through data review, identifying training opportunities and consulting with providers to rectify issues.
  • Manage the distribution of claims corrections and documentation queries, ensuring compliance through post-audit reviews.
  • Monitor improvements in provider coding quality scores resulting from ongoing educational efforts.
  • Engage in region-specific projects as directed by the Director of Auditing.

Qualifications:

  • In-depth knowledge of Risk Adjustment Coding, CMS-HCC Hierarchy Model coding, and relevant industry regulations.
  • Certification as a coder is required (CPC, CRC preferred, CPMA accepted).
  • A minimum of three years of experience in risk adjustment coding and documentation improvement.
  • Ability to identify potential fraud and abuse in coding and documentation practices.
  • Proficiency in conducting thorough chart reviews.
  • Strong skills in Microsoft Office and presentation delivery.
  • Exceptional attention to detail and analytical capabilities.
  • Experience in addressing performance and coding gaps.
  • Willingness to travel as needed.

Note:

Wellvana prioritizes transparency and support for all applicants. We encourage candidates to apply directly through our official channels to ensure the security of personal information and to avoid potential hiring scams.