Risk Adjustment Coder

Dignity Health Management Services•Bakersfield, CA

1d•Remote

About The Position

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave. One Community. One Mission. One California Job Summary and Responsibilities As a Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. Review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor and review network coding opportunities as it pertains to risk adjustment. Ensure that the diagnosis codes for each chronic or major medical condition have been captured and work to educate providers on opportunities to improve documentation on medical conditions. Review clinical documentation across the network to identify patterns and trends in clinical documentation. Work with network providers to improve clinical documentation to better support CMS Risk Adjustment guidelines. Develop education materials and tools to help network providers improve clinical documentation and support Hierarchical Condition Category (HCC) coding capture. Participate network performance improvement initiatives. Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security. This position is remote.

Requirements

Associates degree or equivalent work experience
CPC, CRC, CCS, CCS-P, or RHIT
Advanced knowledge of CPT and ICD-10 coding
Knowledge of federal and state guidelines on all coding systems and sponsored programs.
Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements.
Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, at multiple practice locations, with significant attention to detail for completion of both verbal and written external communications.
Computer literacy of medical information system, records management software, encoders.
Must have excellent verbal communication skills.
Proficiency in MS office (Outlook, Excel, Word).

Nice To Haves

2-3 years of experience in risk adjustment/HCC coding strongly preferred

Responsibilities

Review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor and review network coding opportunities as it pertains to risk adjustment.
Ensure that the diagnosis codes for each chronic or major medical condition have been captured and work to educate providers on opportunities to improve documentation on medical conditions.
Review clinical documentation across the network to identify patterns and trends in clinical documentation. Work with network providers to improve clinical documentation to better support CMS Risk Adjustment guidelines.
Develop education materials and tools to help network providers improve clinical documentation and support Hierarchical Condition Category (HCC) coding capture.
Participate network performance improvement initiatives.
Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security.