Risk Adjustment Coder

Carina Health Network•Denver, CO

6d•Hybrid

About The Position

Carina Health Network is hiring a Risk Adjustment Coder for a hybrid role. The employee must be located in Colorado and will work from home with travel within the state. The role supports community health organizations (CHOs) by identifying risk adjustment and HCC coding opportunities and providing education to providers, billers, coders, support staff, and Carina staff. It also supports value-based contract initiatives, quality reporting, and gap closure through pre-visit planning, chart reviews, and compliant documentation.

Requirements

High school diploma or equivalent.
At least 2 years of coding experience.
Risk Adjustment experience.
AAPC Certified Risk Adjustment Coder (CRC) or AHIMA certification; CPC certification may be considered with Risk Adjustment/HCC coding experience and willingness to obtain CRC within 1 year of employment.
Experience with clinic billing and coding.
Strong knowledge of CMS coding and quality guidelines.
Knowledge of PowerPoint, Excel, and Microsoft Word, including ability to manipulate basic information and data for reports and training.
Ability to travel within Colorado (25%) with an unrestricted driver’s license and an insured vehicle.

Nice To Haves

FQHC billing experience is highly preferred.
Knowledge of EHR systems such as ECW, Athena, Greenway Intergy, or Epic.
Clinical background.
Exceptional interpersonal, public speaking, and presentation skills for delivering training and education.
Ability to facilitate group discussions that challenge participants and promote discussion of data-informed approaches and solutions based on value-based care initiatives.

Responsibilities

Educate providers and staff on coding regulations and changes related to risk adjustment and quality reporting, supporting compliance with federal and state regulations.
Assist with developing educational tools and training for risk adjustment/HCC coding and gap closure.
Maintain a database of medical chart review results and report progress and statistics on coding initiatives.
Conduct weekly pre-visit planning reviews for assigned CHOs, including reviewing internal and external medical records, payer portals, suspected conditions, care gaps, and clinical documentation; query providers or other team members as needed.
Hold monthly meetings with coding champions and provide coding-guideline and documentation education based on pre-visit planning observations and monthly topics.
Review charts monthly for randomly selected patients and providers participating in the pre-visit planning program, and provide feedback on missed opportunities and errors.
Review patient charts to identify quality gap closure opportunities and provide compliant documentation to appropriate payers.
Ensure providers understand CPT II coding for quality gap closure and reporting.

Benefits

Group health, dental, and vision plans; the employer covers 100% of the cost of dental and vision.
Medical and dependent care flexible spending account options.
$900 employer contribution toward a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA).
401(k) retirement plan with up to a 4% employer contribution match.
Employer-paid life, AD&D, short-term disability, and long-term disability plans.
Free 24/7 access to confidential resources through an Employee Assistance Program (EAP).
Voluntary accident, critical illness, and hospital indemnity insurance plans.
17 days of paid vacation within 1 year of service.
12 paid sick days accrued by 1 year of service.
14 paid holidays, including 2 floating holidays.
1 paid volunteer day.
Employer-paid programs and courses for staff growth and development.
Cell phone and internet reimbursement.
Annual, all-expenses-paid staff retreat.
Flexible remote or hybrid work.
Supportive, mission-driven team and opportunities to learn and grow.