Risk Adjustment Coder

Carina Health Network•Denver, CO

7d•$63,000 - $73,000•Hybrid

About The Position

Carina Health Network is hiring a Risk Adjustment Coder for a hybrid role. The position must be based in Colorado and includes work from home with 25% travel within the state. The role works with operational and clinical leadership to identify risk adjustment and HCC coding opportunities and provides targeted education to community health organization (CHO) providers, billers, coders, and support staff to support value-based contract initiatives. The role educates providers and staff on coding regulations and changes related to risk adjustment and quality reporting, helps develop education tools, and supports training for CHO and Carina staff. It maintains a database of medical chart review results and reports progress and coding initiative statistics. The coder performs weekly pre-visit planning reviews for assigned CHOs, using internal and external medical records, payer portals, suspected conditions, care gaps, and clinical documentation to make coding recommendations and support value-based initiatives. The position also holds monthly meetings with coding champions, delivers coding and documentation education, conducts monthly reviews of randomly selected patient charts and providers participating in the pre-visit planning program, and provides feedback on missed opportunities and errors. It reviews charts to identify quality gap closures, provides compliant documentation to appropriate payers, and helps providers understand CPT II coding for quality gap closure and reporting. Carina Health Network describes its work as supporting community health organizations through proactive, data-informed, whole-person care and value-based care programs. The organization is an equal opportunity employer committed to diversity and an inclusive environment.

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.
Strong knowledge of PowerPoint, Excel, and Microsoft Word, with ability to manipulate basic information and data for reports and training.
Ability to travel within Colorado, with an unrestricted driver’s license and an insured vehicle.

Nice To Haves

FQHC billing experience is highly preferred.
Knowledge of several EHR systems, such as ECW, Athena, Greenway Intergy, and 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 new approaches and solutions based on data and 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 in developing education tools related to risk adjustment/HCC coding and gap closure.
Support the creation of training for CHO providers, billers, coders, support staff, and Carina staff on risk adjustment/HCC coding opportunities.
Maintain a database of medical chart review results and report progress and statistics on coding initiatives.
Perform weekly pre-visit planning reviews for assigned CHOs and query providers or other identified team members as needed.
Make coding recommendations for value-based contract initiatives using internal and external medical records, payer portals, suspected conditions, care gaps, and clinical documentation.
Hold monthly meetings with identified coding champions and provide coding guidelines and documentation education based on pre-visit planning observations and monthly topics.
Conduct monthly chart reviews of 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.
Travel within Colorado, including to assigned community health organizations.

Benefits

Insured group health, dental, and vision plans; employer covers 100% of dental and vision costs.
Medical and dependent care flexible spending account options.
$900 employer contribution toward a choice of HRA or 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.
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 work options (remote or hybrid).
Competitive salary and full benefits.