Senior Risk Adjustment Specialist

Viva Health•Birmingham, AL

About The Position

The Senior Risk Adjustment Specialist reviews medical records to ensure all ICD-10-CM codes are accurate and compliant with supportive documentation for submission to the Centers for Medicare and Medicaid Services (CMS). This role is a resource for the Risk Adjustment Specialists and provides subject matter expertise. VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Requirements

High School Diploma or GED
At least 5-7 years' experience with coding
Certified Coder (AHIMA or AAPC credentials)
Read and interpret handwritten and typewritten medical documentation
Ability to work under pressure to meet deadlines with minimal supervision
Basic computer skills
Ability to maintain flexible work schedule to meet department needs required
Demonstrate excellent customer service skills through written and verbal communication
Demonstrate leadership among coding team

Nice To Haves

2 or more years of college
Experience with hospital coding

Responsibilities

Maintain thorough understanding of the risk-adjusted payment methodology; what can be submitted by the plan and how/when submission impacts CMS payments.
Demonstrate knowledge of ICD10 coding guidelines, medical terminology, disease processes, and pharmacology.
Interpret and demonstrate analytical and problem-solving ability to accurately assign ICD10 codes that are clinically identified and supported in the medical record.
Work with department management to communicate provider coding accuracy concerns and challenges.
Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines.
Report findings of chart audits and Clinical Documentation Improvement (CDI) opportunities to providers to maximize the coding of ongoing risk adjusted conditions.
Query providers when necessary to obtain clarification for unclear documentation.
Collaborate with providers regarding coding changes, questions concerning documentation, diagnosis coding, and level of service.
Conduct chart reviews to identify clinically supported diagnoses based on CMS-HCCs and specific HEDIS measures.
Support any ongoing program that minimizes any organizational risk in the event of a Risk Adjustment Data Validation (RADV) audit.
Communicate with Department Management to keep abreast of potential risk exposure related to coding and/or documentation practices by providers and/or coding personnel.
Provide support and compliance through effective communication and training/education.
Train and mentor new Risk Adjustment Specialists.
Assist management with workflow improvements and process optimization.
Serve as an escalation point for complex coding questions and issues.
Monitor provider coding performance and trends.
Evaluate coding practices for regulatory and compliance risk.
Support RADV audits, validations, and related projects.