Risk Adjustment Coding Specialist

4 weeks ago


Charlotte, North Carolina, United States Tryon Medical Partners Full time
Job Summary:

The Risk Adjustment Coder and Educator is a critical role within our organization, responsible for providing expertise in risk adjustment coding for assigned provider groups. This includes reviewing medical records, identifying, collecting, assessing, monitoring, and documenting claims and encounter information related to risk adjustment for Medicare and Commercial patient populations.

This position interacts with Value-Based Care (VBC) leadership to assist in identifying operational and clinical best practices in maximizing recapture rates, understanding clinical suspects, and monitoring appropriate clinical documentation and coding.

Primary Responsibilities:
  • Provides guidance and consultation to assist providers in understanding Risk Adjustment coding as it relates to payment methodology and the importance of proper chart documentation of diagnosis codes.
  • Educates providers about the CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding, in accordance with Tryon Medical Partners' policy.
  • Supports providers by ensuring documentation supports the submission of relevant ICD-10 codes and CPT II procedural information in accordance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines.
  • Routinely consults with providers to clarify missing or inadequate record information to determine appropriate diagnostic codes and obtain additional medical record documentation as needed for accurate coding.
  • Provides thorough, timely, and accurate consultation on ICD-10 and CPT II codes by providers or practice clinical consultants.
  • Provides ICD-10-HCC coding training to new providers and appropriate staff.
  • In conjunction with VBC leadership and Compliance, facilitates education and/or educates providers on proper Risk Adjustment coding and medical record review criteria.
  • Develops and delivers diagnosis coding tools to providers, including presentations and trainings provided to co-workers, management, and other practice staff as needed.
  • Uses results from clinical validation audits to identify trends and improvement opportunities; documents follow-up education provided.
  • Assesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding.
  • Effectively manages special Risk Adjustment coding projects and other tasks as assigned.
Requirements and Qualifications:
  • Ability to travel throughout the Charlotte, NC region to provider group clinic locations.
  • 3+ years of clinic or hospital experience and/or managed care experience.
  • 3+ years of experience in Risk Adjustment with proficiency in ICD-10 and CPT coding.
  • Certified Risk Adjustment Coder AND/OR Certified Professional Coder with the American Academy of Professional Coders with the requirement to obtain both certifications, CRC and CPC, within the first year in position.
  • Proficient in MS Office (Excel, PowerPoint, and Word).
  • Experience working effectively with common office software, coding software, EMR, and abstracting systems.
  • Excellent verbal and written communication skills.
Preferred Qualifications:
  • Bachelor's degree.
  • Knowledge of EMR for recording patient visits.
  • Experience coding in a healthcare facility.
  • Knowledge of billing/claims submission and other related activities.


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