Risk Adjustment Coding Specialist

Millennium Physician Group-posted about 2 months ago
Full-time • Entry Level
Remote • Fort Myers, FL
501-1,000 employees
Ambulatory Health Care Services
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Formed in 2008 and headquartered in Fort Myers, Florida, with offices in Florida, North Carolina, and Texas, Millennium Physicians Group (MPG) is the largest independent physician group in the state of Florida and one of the largest in the United States. At Millennium Physician Group, our employees are the foundation of our success. Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual and help you grow in your role. Under the direction of Burden of Illness department leadership, the Risk Adjustment Coding Specialist is responsible for various aspects of decision-making and coding reviews to facilitate, obtain, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect the severity of illness and complexity of patient care. This position is responsible for risk adjustment coding and quality assurance validation for the following programs, including but not limited to: Prospective medical record review Concurrent outpatient claim diagnosis coding Retrospective medical record and provider response reviews

  • Perform prospective medical record reviews for clinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter.
  • Review the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission to validate completeness and accuracy of provider selected ICD-10-CM codes.
  • Collaborate with healthcare providers and other stakeholders to clarify documentation and ensure accurate coding and reporting of diagnoses.
  • Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.
  • Participate in coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.
  • Stays current on applicable coding and documentation guideline changes and rules.
  • This role is expected to maintain a consistent accuracy rate of 95% or higher and able to meet productivity standards established by leadership.
  • Perform other job-related duties as assigned by leadership.
  • Abstract and assign ICD-10-CM diagnosis codes supported in the encounter documentation not initially assigned to the encounter claim following ICD-10-CM Official Guidelines for Coding and Reporting.
  • Conduct retrospective audits of medical records to validate the accuracy and completeness of diagnosis coding and claim submission, identifying and resolving any discrepancies or areas for improvement.
  • Perform comprehensive reviews of provider actions within the Value Based Alert Tool (VBAT) to identify outliers and areas of opportunity.
  • Analyze MRA data to identify patterns and when requested assist in the development of interventions at the provider and region level.
  • Keeps department leadership apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
  • May be assigned additional projects/higher work volume than Risk Adjustment Coding Specialist I
  • Subject matter experts for proper risk adjustment coding and CMS data validation
  • Acts as a preceptor to new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. Facilitates ongoing training for optimal staff functioning.
  • Research best practices in risk adjustment coding and reviews the professional literature for coding updates, maintaining currency in coding. Evaluates, researches, and recommends enhancements to the risk adjustment program and internal coding guidelines.
  • Proposes and develops new workflows and policies and procedures as needed to support new and existing department initiatives, audits, and projects.
  • Establishes and maintains a repository for storing department documentation which may include corporate share drives, wiki, company intranet, and/or corporate website. Collaborates with other operating teams as needed to support these activities.
  • May occasionally lead workgroups and manage project deliverables for department initiatives, audits, and provider communications.
  • Provides written or oral recommendations to department leadership related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
  • Analyzes and researches provider diagnostic coding issues and patterns through medical record review. Identifies and develops education in relation to provider coding errors and documentation standards as requested by leadership and in conjunction with the Risk Adjustment & Quality Educators.
  • May be assigned additional projects/higher work volume than Risk Adjustment Coding Specialist I and II.
  • High school diploma or GED equivalent
  • Current active coding credential through AAPC or AHIMA required.
  • Maintains active professional certification and complies with all educational, professional, and ethical requirements of said certification.
  • Minimum of one (1) year of experience in medical field, preferably in an outpatient or accountable care organization setting.
  • Proficiency in ICD-10-CM coding guidelines and conventions.
  • Knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
  • Familiarity of Medicare risk adjustment methodologies and HCC coding principles.
  • Excellent diligence and analytical skills, with the ability to review and interpret complex medical documentation.
  • Effective communication and people skills to collaborate with healthcare providers and other team members.
  • Ability to work independently and prioritize tasks to meet deadlines in a fast-paced environment.
  • Proficiency in electronic health record (EHR) systems.
  • Commitment to maintaining confidentiality and adhering to ethical coding standards.
  • Minimum of two (2) years coding experience or directly related medical experience, one (1) of which includes Hierarchical Condition Category (HCC) coding.
  • Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.
  • Extensive knowledge of coding conventions and payment rules as they apply to medical record documentation, billing of medical services, and health care reimbursement systems. This includes a comprehensive understanding of ICD-10-CM.
  • Advanced technical skills for use of MS Office (Excel, Word, Access, and PowerPoint).
  • Demonstrated ability to utilize a variety of electronic medical records systems.
  • Ability to manage significant workload, and to work efficiently under pressure meeting established deadlines with minimal supervision. Strong time management skills. Must possess high degree of accuracy, efficiency, and dependability.
  • Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization both verbally and written.
  • Demonstrated organizational and problem-solving ability.
  • Strong analytical and mathematical skills.
  • Demonstrated experience in project completion, educational program development and/or group presentation.
  • Preference given to those with CRC designation.
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