Sr Risk Adjustment Coder

University Healthcare Alliance•Newark, NE

64d•$44 - $57

About The Position

The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment. Locations Stanford Health Care - University Healthcare Alliance

Requirements

High school diploma or GED equivalent.
5+ years of work experience in a risk adjustment program supporting and communicating with clinicians with prospective and/or concurrent role within a healthcare setting with demonstrated knowledge and of regulatory billing and coding guidelines.
Understanding of the professional revenue cycle preferred.
Knowledge of CPT, HCPCS and ICD-10 codes and rules.
Ability to analyze and develop solutions to complex problems.
Ability to perform research regarding complex coding and regulatory guidelines.
Ability to work effectively both as a team player and leader.
Ability to apply judgment and make informed decisions.
Ability to foster effective working relationships and build consensus.
Ability to make effective oral presentations and prepare concise written reports to a variety of audiences.
Ability to plan, organize, prioritize, work independently and meet deadlines.
Knowledge of computer systems and software used in functional area.
Knowledge of local, state and federal regulatory requirements related to areas of functional responsibility.
Demonstrated knowledge of CPT, HCPCS and ICD-10 codes and rules.
Ability to establish and maintain collaborative effective working relationships.
Ability to bring together multi-disciplinary teams to seek consensus and value problem.
CPC - Certified Professional Coder and CRC - Certified Risk Adjustment Coder

Nice To Haves

Bachelor's Degree preferred.
CCDS - Cert Clinical Document Spec preferred

Responsibilities

Risk Adjustment Review May perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing
Reviewing medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses.
Evaluating medical records to verify that M.E.A.T criteria support the submitted diagnosis codes.
Inquire with clinicians the recommended HCC diagnosis for chart addendum.
Collaborating with other departments to address coding updates and support risk adjustment programs.
Compliance Reporting Tracking and reporting review results that will be used to develop education and training materials on risk adjustment coding and/or documentation best practices.
Assist with the implementation of emerging coding and compliance laws and regulations and assist with implementing privacy policies.
Maintain current knowledge of risk adjustment coding guidelines by conducting research, reading professional publications, and maintaining professional networks.
Attending coding seminar, webinars and medical organization meetings.
All other duties as assigned including department-specific functions and responsibilities:
Performs other duties as assigned and participates in organization projects as assigned.
Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.