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Risk Adjustment Coding Specialist

2 months ago

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

About Wellvana Integration Partners, LLC:

At Wellvana, we are committed to transforming the healthcare landscape. Our mission is to empower healthcare providers to deliver exceptional care through innovative value-based programs.

Position Overview:

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

Key Responsibilities:

  • Provide comprehensive education to healthcare providers regarding the purpose of risk adjustment, CMS-HCC coding regulations, and documentation practices for various patient types.
  • Conduct training on Prospective, Retrospective, and Concurrent review processes.
  • Establish and nurture professional relationships with providers and their teams through regular in-person visits.
  • Disseminate educational resources and coding tools, guiding providers in utilizing technology to identify potential unreported conditions.
  • Collaborate with internal teams, including Practice Transformation Specialists and Audit teams, to ensure effective provider education.
  • Analyze documentation and coding data to identify error trends, providing corrective guidance to providers and billing staff.
  • Manage 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, and industry regulations, with the ability to communicate effectively in both individual and group settings.
  • Certification as a coder is required; CPC and CRC certifications are preferred.
  • 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 in accordance with regulatory guidelines.
  • Experience conducting thorough chart reviews as necessary.
  • Proficiency in Microsoft Office and strong presentation skills.
  • Exceptional attention to detail and analytical abilities.
  • Experience in addressing performance and coding gaps.
  • Willingness to travel as required.

Disclaimer:

At Wellvana, we prioritize transparency and support for all applicants. We encourage candidates to apply directly through our official channels to protect personal information and ensure a legitimate hiring process.