Risk Adjustment Coding Specialist

1 day ago


Long Beach, California, United States Advanced Medical Manage Full time
Job Description

**Job Summary**

The Risk Adjustment Coding Specialist is responsible for managing and training on Risk Adjustment HCC coding to ensure effective collaboration between physicians, office staff, and health plan representatives to achieve goals.

**Key Responsibilities**

  • Review medical records to identify, collect, assess, monitor, and document claims and encounter coding information related to Hierarchical Condition Categories (HCC)
  • Audit provider documentation of CPT, ICD-9, and ICD-10 codes to ensure adherence to coding and CMS Risk Adjustment guidelines
  • Evaluate HCC auditing processes and provide analyses and recommendations to improve overall provider documentation and coding
  • Responsible for ongoing provider education on HCC
  • Support and participate in process and quality improvement initiatives
  • Meet productivity and quality standards
  • Review Comprehensive Annual Wellness Examination (CAPE) forms
  • Perform other duties as required

**Requirements**

  • Bilingual proficiency in Korean preferred but not required
  • Minimum 2 years HCC coding experience required
  • Certified Medical Coder with either CPC or CCS
  • Knowledge of Medicare managed care
  • Cultivate positive professional and interpersonal relationships with providers and IPA
  • Excellent verbal and written communication skills
  • Effective organizational skills
  • Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information
  • Ability to work both independently and as part of a team
  • Must be able to achieve and maintain an accuracy standard of 95% and better
  • Knowledge of Outlook, Word, Excel, and PowerPoint
  • EMR experience
  • Must possess a reliable vehicle and clean and unrestricted CA driver's license
  • Must be able to travel


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