HCC Risk Adjustment Coding Coordinator

University of Iowa•Iowa City, IA

About The Position

UI Health Care has a new opportunity for an HCC Risk Adjustment Coding Coordinator to join Finance and Accounting's Revenue Integrity team. The position plays a pivotal role in ensuring the accuracy and completeness of HCC (Hierarchical Condition Categories) risk coding to optimize risk-adjusted payment models and improve patient outcomes. Under the direction of the Risk Adjustment Program Manager, the HCC Risk Adjustment Coding Coordinator is responsible for supporting all aspects of the UI Health Care Risk Coding Program, including but not limited to pre-visit coding support, provider and coder education, and post-visit auditing. The ideal candidate will possess a thorough understanding of risk coding methodologies and risk adjustment, and the ability to drive compliance and performance across multiple departments in a complex healthcare environment.

Requirements

Bachelor’s degree in healthcare administration, business, finance, or a related field or an equivalent amount of education and experience is required.
CPC, CRC, CCS-P, CCS-H, RHIT, or RHIA certification is required.
1 year of experience in risk adjustment medical coding
Strong knowledge of HCC coding guidelines, CMS risk adjustment models, and regulatory requirements.
Knowledge of insurance regulations and Medicare and Medicaid guidelines as related to clinical documentation and clinical indicators
Strong problem-solving and research skills
Strong clinical knowledge related to chronic illness diagnosis, treatment and management
Ability to interpret CMS regulations and guidance
Demonstrated ability to provide coding advice to all areas of coding staff, other departments throughout UI Health Care, and other entities as requested
Ability to analyze complex clinical scenarios and apply critical thinking
Proven ability to effectively plan, prioritize, and organize tasks to achieve strategic goals
Excellent written, verbal, and interpersonal communication skills
Proficiency with MS Word, PowerPoint, and Excel, including database and spreadsheet analysis
Demonstrated experience working effectively in a welcoming and respectful workplace environment.

Nice To Haves

3+ years in risk adjustment medical coding
Experience with Medicare Advantage, MSSP, or other value-based care models
Familiarity with population health initiatives and care coordination in an ACO or similar setting
Experience performing coding audits
Knowledge of UI Health Care policies and procedures
CRC certification
Experience with Epic

Responsibilities

Support the HCC risk adjustment coding program across the organization, ensuring that coding practices align with CMS guidelines and other regulatory requirements.
Collaborate with clinical, operational, and financial leaders to optimize HCC coding and documentation workflows.
Review documentation available in the medical record (Epic) to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients.
Utilize available coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs.
Actively participate in and maintain coding quality and productivity benchmarks.
Collaborate with department and coding teams to perform retrospective and other targeted medical record reviews, ensuring documentation accuracy, evaluating clinical severity, identifying quality concerns, and supporting continuous improvement across evolving review priorities.
Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements.
Develop and implement educational programming for providers, departments, and clinic staff relating to risk coding and documentation compliance as well as new policies and procedures.
Engage with cross-functional teams and stakeholders, fostering a culture of collaboration and continuous improvement.
Stay up to date with changes in HCC coding regulations, ensuring organizational compliance, and implementing necessary updates to processes.