Risk Adjustment Coding Specialist II
About The Position
This role involves abstracting and assigning ICD-10-CM diagnosis codes based on encounter documentation, conducting retrospective audits of medical records for coding accuracy and claim submission quality, and performing comprehensive reviews of provider actions within the Value-Based Alert Tool (VBAT) to identify outliers and improvement opportunities. The specialist will analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions. This position requires keeping leadership informed of project activities, proactively identifying project risks, and consistently meeting or exceeding accuracy and productivity benchmarks. The role may involve additional projects or a higher workload volume than a Level I specialist.
Requirements
- Minimum 2 years of coding or related medical experience, including 1 year of HCC coding.
- Advanced knowledge of medical terminology, anatomy, physiology, and disease processes.
- Extensive understanding of ICD‑10‑CM conventions, documentation standards, and reimbursement systems.
- Strong technical skills, including proficiency with MS Office (Excel, Word, Access, PowerPoint).
- Demonstrated ability to use a variety of electronic medical record systems.
- Ability to manage a significant workload and meet deadlines with minimal supervision.
- Strong organizational, analytical, mathematical, and problem‑solving skills.
- Effective written and verbal communication abilities.
Nice To Haves
- Experience contributing to project work, educational development, or group presentations.
Responsibilities
- Abstract and assign ICD‑10‑CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher‑level coders.
- Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
- Perform comprehensive reviews of provider actions within the Value‑Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
- Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
- Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
- Consistently meet or exceed accuracy and productivity benchmarks.
- May be assigned additional projects or a higher workload volume than a Level I specialist.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
