Risk Adjustment Coding Specialist

Employment Type:

Full time

Shift:

Day Shift

Description:

Risk Adjustment Coding Specialist -St. Peter's Health Partners - Full-time - Remote

POSITION PURPOSE:

The Risk Adjustment Coding Specialist works in a team environment and is responsible for reviewing clinical documentation and coding using HCC (Hierarchical Condition Category) and M.E.A.T (Monitored, Evaluated/Assessed/Addressed, Treated) standards while adhering to coding guidelines established by the Centers for Medicare and Medicaid Services (CMS).

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

• Certified Risk Adjustment Coder (CRC) required
• Excellent verbal and written communication skills.
• Customer service-oriented attitude/behavior.
• Detail oriented with the ability to multi-task and complete tasks in a timely manner.
• Ability to work well as a team member.
• Intermediate computer skills: typing, 10-key, Word, Excel, Outlook and Teams.
• High School Diploma or GED

ESSENTIAL FUNCTIONS:

Meets Health System's Guiding Behaviors and Caring Standards including interpersonal communication and professional conduct expectations with all coworkers, other departments, and with patients and visitors. Accurately codes (ICD-10-CM) to the most appropriate level of specificity. Follows current industry standards of ethical coding. Recognizes and reports opportunities for documentation improvement to the Supervisor of Risk Adjustment Coding& Audit to develop and implement provider documentation improvement plans. Ensures medical documentation and coding compliance with Federal, State and Private payer regulations. Participates in continuing education activities to maintain their certification(s) and pertinent to areas of job responsibility. Performs additional duties as assigned. Adheres to St. Peter's Health Partners' confidentiality requirements as they relate to patient information.

What a Certified Risk Adjustment Coding Specialist will do:

• Review and assigns accurate ICD-10-CM codes for diagnoses assigned in the EHR by the providers to claims being submitted for their services. Using billing system work queues and natural language processing (NLP) tools to support addressing HCC codes for Risk Adjustment before a claim is submitted to payers.
• Demonstrate a solid understanding of ICD-10-CM coding and medical terminology, Hierarchical Condition Category (HCC), and M.E.A.T standards.
• Exercise thorough understanding of ICD-10-CM coding guidelines, payer regulations, compliance and reimbursement and the effects of coding in relation to risk adjustment payment models.
• Identify coding discrepancies and work with risk adjustment auditor to communicate deficiencies to providers.

Core Values:

• Reverence: We honor the sacredness and dignity of every person.
• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.
• Justice: We foster right relationships to promote the common good, including sustainability of Earth.
• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.
• Integrity We are faithful to those we say we are.
• Safety: We embrace a culture that prevents harm and nurtures a healing, safe environment for all.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

• Must be able to set and organize own work priorities and adapt to them as they change frequently.
• Must be able to work concurrently on a variety of tasks/projects in physical or virtual environments

that may be stressful with individuals having diverse personalities and work styles.

• Must possess the ability to comply with Trinity Health policies and procedures.
• Must be able to spend majority of work time utilizing a computer, monitor, and keyboard.
• Must be able to perform some lifting and/or pushing/pulling up to 20 pounds if applicable.
• Must be able to work with interruptions and perform detailed tasks.
• If applicable, involves a wide array of physical activities, primarily walking, standing, balancing, sitting, squatting, and reading. Must be able to sit for long periods of time.
• 100% remote but if local may include some travel to sites.
• Must be able to travel to various Trinity Health sites (10%) as applicable.
• If applicable, telecommuting (working remotely), must be able to comply with Trinity Health's and the Region/RHM Working Remote Policy.

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Please be aware for the safety and security of our colleagues and patients all new employees are required to undergo and pass all applicable state and federally mandated pre-employment screening requirements including:

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Pay range: $24.60-$35.70

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.