Coder Auditor-Risk Adjustment

- Managed Care (Remote, Hybrid, Full-Time, Day Shift) -

Our mission is to participate in Jesus Christ's ministry, bringing health, healing, and wholeness to humanity by: Creating a supportive faculty practice framework that allows Loma Linda University School of Medicine physicians and surgeons to educate, conduct research, and deliver quality health care with optimum efficiency, deploying a motivated and competent workforce trained in customer service and whole person care principles and providing safe, seamless and satisfying health care encounters for patients while upholding the highest standards of fiscal integrity and clinical ethics. Our core values are compassion, integrity, humility, excellence, justice, teamwork and wholeness.

The Coder Auditor-Risk Adjustment is responsible for the reconciliation of Clinical Documentation Integrity (CDI) clarification against final coded outcomes to ensure accurate and timely encounter data submission as outlined within Risk Adjustment Health Plans (i.e. Medicare Advantage). Evaluates provider documentation in context of completed documentation, final code diagnosis, severity of illness and supporting clinical care plan(s) as it pertains to Risk Adjustment for the validation of Hierarchical Condition Category (HCC) diagnoses. Maintains the HCC Management database and LLEAP work queues, ensuring that all data elements are thoroughly and consistently updated. Provides formal education and training programs related to CMS, RADV, ICD-10-CM, AHA Coding, health plan and other regulatory documentation guidelines as it pertains to Risk Adjustment for Clinical Documentation Specialists and providers Performs internal team audits ensuring Clinical Documentation Specialists maintain at least 95% coding and medical record review accuracy. Performs concurrent, prospective, and retrospective clinical documentation review within the designated timeframe after encounter closure, with emphasis on completeness, accuracy, and supporting clinical care plan(s) as it pertains to Risk Adjustment Data Validation (RADV) timelines.

Performs other duties as needed.

Bachelor's degree in Health Information Management or other clinical/healthcare degree required; however, an equivalent combination of education and experience that provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements.8+ years overall combined clinical/medical experience with at least 5+ year of Risk Adjustment coding specific experience or Clinical Documentation Improvement/Specialist equivalent
Comprehensive understanding of the contents of a typical electronic medical record, medical terminology, abbreviations, ICD-10-CM coding conventions. Expertise in CMS Risk Adjustment Data Validation (RADV) for Medicare Advantage Plans, and medical coding, including but not limited to E/M, ICD-10, CPT, and HCC coding preferred. Able to keyboard 40 wpm. Able to read; write legibly; speak in English with professional quality; use computer, printer and software programs necessary to the position; operate/troubleshoot basic office equipment require for the position. Able to relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following or enforcing policies; work calmly and respond courteously when under pressure; collaborate; and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; work independently with minimal supervision; performs basic math functions; manage multiple assignments effectively; work well under pressure; problem solve; organize and prioritize workload; recall information with accuracy; pay close attention to detail. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, medical records, and written documents necessary to position.
Certified Risk Adjustment Coder (CRC) required; and Certified Clinical Documentation Specialist (CCDS) preferred or equivalent. Active California LVN License preferred.
Our mission is to continue the teaching and healing ministry of Jesus Christ. Our core values are compassion, excellence, humility, integrity, justice, teamwork and wholeness.
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