Risk Adjustment Coding Specialist II Full Time

Trinity Health•Boise, ID

3d•Hybrid

About The Position

At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care. Saint Alphonsus is looking to hire a Risk Adjustment Coding Specialist II for our SAMG Population Health. This position will be located in Boise, but will have the opportunity to work from home. It is full time, 40hours a week, and is benefit eligible. The Risk Adjustment Coding Specialist will be responsible for the creation and/or compilation of educational materials and conducting coding and documentation education with providers, the clinic care team and coding/billing staff The Risk Adjustment Coding Specialist may also conduct medical record audits for risk adjustment and core quality measures and assist with other performance improvement initiatives that promote the success of Advanced Payment Model (APM) contracts. The position is responsible to work with all applicable payer partners for varying arrangements spanning across Medicare, Medicare Advantage, Commercial, QHP and Medicaid, and will leverage data and reports to maximize clinical condition documentation (CCD), and will become familiar with risk adjustment methodologies as applicable (HCC/RAF, HHS, MARA, Johns Hopkins, etc.) The Risk Adjustment Coding Specialist will provide insights and direct contributions to the development of analytics and reporting to enhance providers' ability to document and code to the highest level of specificity and improve coding and recapture rates as is clinically appropriate. The role will maintain strict confidentiality of all data and information. The Risk Adjustment Coding Specialist will develop and maintain collaborative relationships with internal and external partners to ensure effective, results-oriented project outcomes.

Requirements

Minimum of 2 years of experience working in risk adjustment coding in a medical practice, network or payer setting using electronic health records (EHR) required.
Minimum of 4 years coding experience required.
Certified Risk Adjustment Coder (CRC) required.
AAPC or AHIMA coding credential required.
High school diploma or equivalent required.

Nice To Haves

Chart auditing experience preferred.
Associates/Bachelor's Degree or some college preferred.

Responsibilities

Create and/or compile educational materials.
Conduct coding and documentation education with providers, clinic care teams, and coding/billing staff.
Conduct medical record audits for risk adjustment and core quality measures.
Assist with performance improvement initiatives that promote the success of Advanced Payment Model (APM) contracts.
Work with applicable payer partners for varying arrangements across Medicare, Medicare Advantage, Commercial, QHP, and Medicaid.
Leverage data and reports to maximize clinical condition documentation (CCD).
Become familiar with risk adjustment methodologies (HCC/RAF, HHS, MARA, Johns Hopkins, etc.).
Provide insights and direct contributions to the development of analytics and reporting to enhance providers' ability to document and code to the highest level of specificity and improve coding and recapture rates as is clinically appropriate.
Maintain strict confidentiality of all data and information.
Develop and maintain collaborative relationships with internal and external partners to ensure effective, results-oriented project outcomes.