Risk Adjustment Coder
About The Position
The Risk Adjustment Coder supports the risk and quality team, IPA Administrators, and the VP of Operations on Clinical Initiatives to improve patient outcomes and group quality measures across Risk Adjustment, CMS 5 Star, commercial, and Medi-Cal programs. The role coordinates member outreach for preventive and chronic care needs, supports provider education, collaborates with health plans, and monitors medical record retrieval and potential project issues. The position requires at least two years of Risk Adjustment coder experience, knowledge of managed care processes, understanding of medical terminology, clear communication skills, and proficiency with Word and Excel. The successful candidate performs accurate and timely work, exercises sound judgment, manages competing priorities, takes initiative, and communicates professionally.
Requirements
- At least two years of Risk Adjustment coder experience.
- Knowledge of managed care processes, generally acquired through one or more years of experience in a Health Plan, IPA, or Medical Group environment.
- Ability to communicate clearly and effectively, verbally and in writing, with internal and external customers.
- Understanding of medical terminology, generally acquired through a relevant course or two or more years in a medical office setting or utilization management department.
- Fast, accurate typing skills and proficiency with computer software, including Word and Excel.
- Ability to produce accurate and timely work and perform position requirements with minimal supervision.
- Ability to take initiative, follow through, manage time, and prioritize multiple tasks to meet required timeframes.
- Excellent interpersonal skills and professional, clear, respectful communication.
- Ability to interpret and apply departmental policies and procedures using sound judgment.
Responsibilities
- Outreach to and coordinate care for IPA members who need preventive and/or chronic care services, including mammograms, colonoscopies, and care for uncontrolled HbA1c or blood pressure.
- Collaborate with Risk Adjustment and quality teams on provider education.
- Maintain knowledge of clinical initiatives and Risk Adjustment program requirements.
- Maintain knowledge of 5 Star performance and Risk Adjustment factors for all IPAs.
- Collaborate with health plans on 5 Star, commercial, and Medi-Cal gap reports.
- Coordinate outreach to PCP offices regarding member due reports, including the No Annual Visits list.
- Provide ongoing education to PCP offices on quality measures.
- Work with health plans to provide supplemental data.
- Review, monitor, and track medical record retrieval reports to identify provider issues, including refusals to comply with medical record requests.
- Identify and follow through on potential issues affecting the Risk Adjustment project.
- Contribute to a fair and positive work environment.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
