Risk Adjustment Coding Specialist, Baptist Health Integrated Care, FT, 8A-4:30P

Baptist Health

271d • $22 - $27 • Remote

About The Position

Baptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 28,000 employees, 4,500 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. Baptist Health is supported by philanthropy and committed to its faith-based charitable mission of medical excellence. Our mission, vision, and values make us who we are at Baptist Health and are at the center of everything we do. At Baptist Health, we positively impact the human experience for patients, employees, and physicians. Our successes from a culture of quality and dedication that is instilled into every member of the Baptist Health family. This year, and for 24 years, we've been named one of Fortune's 100 Best Companies to Work For, based on employee feedback. We've also been recognized as one of America's Most Innovative Companies and People Magazine included us in 50 Companies That Care. Based on the U.S. News & World 2024-2025 Best Hospital Rankings, Baptist Health is the most awarded healthcare system in South Florida, with its hospitals and institutes earning 45 high-performing honors. But really, the reason we're excited to come to work is the people. Working together, we form personal connections with our colleagues that are stronger than most of us have experienced at other jobs. We develop caring relationships with our patients and their families that go beyond just delivering healthcare. After all, we know what it's like to be in their shoes. Many of us have been patients and have had family members as patients. We're committed to delivering quality care in the most passionate way possible because we feel a personal stake in the outcomes. When it comes to caring for people, we're all in.

Requirements

• High School diploma or equivalent (Cert, GED, Trn, Exper).
• AAPC Certified Professional Coder.
• AAPC Certified Risk Adjustment Coder.
• Certified Professional Coder and/or Certified Risk Adjustment Coder (CRC).
• CRC certification must be obtained within 1 year of hire.
• Required completion of an accredited certified coding specialist program.
• 2+ years of clinic or hospital experience and/or managed care experience.
• 1+ years of experience in Risk Adjustment and HEDIS/Stars.
• Ability to interpret, analyze and abstract data/documentation.
• Comprehensive knowledge of ICD-10-CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models.
• Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines.
• Intermediate level of proficiency in MS Office - Excel, PowerPoint, and Word.
• Ability to defend coding decisions to both internal and external audits.
• Strong organizational skills in multiple settings, as well as the ability to exercise judgment and initiative.
• Ability to work in a continuously changing environment.

Responsibilities

• Perform medical record reviews prior to and following annual wellness visits and other identified visits to determine appropriate ICD-10-CM coding and billing compliance with Medicare Risk Adjustment metrics.
• Support continuum of patient care by identifying patients with gaps in care or in need of MRA metrics reporting prior to each qualified visit.
• Document detailed chart audit findings including documentation errors, diagnosis errors as well as missed HCC opportunities in applicable audit tools on a daily basis.
• Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding.
• Identify and document coding observations or discrepancies and provide information to management team to further enhance quality and/or provider education.
• Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
• Facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness diagnoses.
• Provide measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices.

Benefits

• Estimated pay range for this position is $22.87 - $27.67 / hour depending on experience.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: High school or GED