Risk Adjustment Coding Specialist

**Risk Adjustment Coding Specialist**
at New England Quality Care Alliance (NEQCA)

NEQCA Central

****I. GENERAL SUMMARY:****
The Risk Adjustment Coder/Auditor works under the direct supervision of the Coding Manager and collaboratively with others in the organization, including ACO support staff, quality specialists, HIS team and clinical staff. The coders primary responsibilities are to code, abstract and analyze outpatient medical records using ICD.10 and CPT coding guidelines and educate network providers on proper documentation and coding practice. The coder will perform these medical record reviews to ensure proper medical diagnoses are coded appropriately and that the members medical record documentation supports the codes accurately in accordance with CMS, CPT and ICD.10 guidelines.
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****II. PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:****
* Perform chart reviews which include coding, abstracting and analyzing outpatient medical records using ICD.10 coding guidelines. Assign ICD.10 diagnostic codes for all conditions addressed in the documentation for the encounter.
* Candidate must demonstrate knowledge of CMS Medicare Advantage, the ACA, value-based medicine, ACOs and other alternative payment models.
* Assist providers with accurate maintenance of the EHR problem list and other coding functions.
* Act as a resource for network providers for diagnosis coding in ICD.10, CPT coding and risk adjustment methodology.
* Develop and distribute educational materials and provide training and education to the network on coding and documentation related subjects.
* Ensure that ICD-10 diagnoses are reported in accordance with CMS payment and Risk Adjustment guidelines.
* Some travel throughout eastern Massachusetts to provider organizations to perform coding duties is required.
* Participate in provider education activities; including the development of educational material.
* Consistently meet daily productivity expectations while maintaining a pre-determined level of coding quality and accuracy.
* Actively participate in internal / external meetings, training sessions
* Provide feedback and trending to leaders
* Facilitate provider education training, on-line or in person.
* Provide feedback and auditing results to providers
* Participate in special projects and other activities associated with the Risk Adjustment program as needed.
****III. JOB KNOWLEDGE AND SKILLS****
* Certified professional coder (CPC) or certified risk coder (CRC)
* Ability to interact with all levels of management and to interact well with physicians
* Familiarity with Risk Adjustment methodology
* Advanced knowledge of ICD.10 coding required
* Expert knowledge of medical terminology and abbreviations and disease, illness and injury processes
* Working knowledge of CMS risk adjustment model preferred
* Presentation and training experience necessary
* Knowledge of Microsoft Office, including Word and Excel
* Excellent written and verbal communication skills
** IV. **EDUCATION****
* Bachelors Degree or higher preferred
* CEUs for risk accepted in lieu of CRC
* 2-4 years professional coding experience; risk adjustment coding experience preferred.
** V. **WORKING CONDITIONS/PHYSICAL DEMANDS:****
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*Work is in a fast paced office-based setting.*
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*Reliable transportation is necessary. The NEQCA office is located in Braintree with travel to Local Care Organizations and community hospitals.*
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*Work often includes meetings outside of normal business hours*

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