Risk Adjustment Coding Specialist (Remote)

CareFirst•Baltimore, MD

1d•Remote

About The Position

The Risk Adjustment Coding Specialist supports the retrospective risk adjustment supplemental filing, HHS-Risk Adjustment Data Validation (RADV) audit and any other chart coding functions, by performing moderately complex medical record review and coding, ensuring compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines. The development and ongoing maintenance of the Commercial Risk Adjustment Coding guidelines, as well as, guiding junior coding specialists are included in the job responsibilities. We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

Requirements

Associate's Degree in Health Information Technology, Business or related field OR in lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience.
CCS-Certified Coding Specialist or CPS, CCS-P, CRC Upon Hire Required or RHIT - Registered Health Information Technician or RHIA Upon Hire Preferred
3 years risk adjustment/hierarchical condition category (HCC) coding experience.
Adobe Acrobat Professional.
Microsoft Word, Excel, Outlook, Claims Processing, Facets.
Ability to adapt to various coding technology platforms, such as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems and coding documentation platforms.
Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Must be eligible to work in the U.S. without Sponsorship

Nice To Haves

RHIT - Registered Health Information Technician or RHIA Upon Hire Preferred

Responsibilities

Verifies accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation provided at all levels of complexity.
Utilizes appropriate coding guidelines and recommends any changes to diagnosis codes based on chart review.
Achieves and maintains coding accuracy levels greater than 90%.
Works with vendors, providers and hospital staff to coordinate record access.
Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education.
Work with leadership and third-party vendors to negotiate agreement on complex medical record diagnoses and determine compliance with coding guidelines which will be accepted by the federal government.
Develops and conducts new physician/other healthcare practitioner coding orientation/education, including group or individual sessions.
Develop and maintain coding guidelines for Commercial Risk Adjustment, maintaining those guidelines for any changes in industry standards.
Provide guidance and direction to Coding Specialists when reviewing complex medical records to help guide in determining appropriate coding.