Risk Adjustment Coding Specialist - Remote / Telecommute

Job TitlePay Range: $31.03hr - $36.03hrRequirement/Must HaveAssociate's degree in Health Information Technology, Business, or a related field.Instead of an Associate's degree, an additional 2 years of relevant work experience is required in addition to the required work experience.3 years of risk adjustment and/or hierarchical condition category coding experience.Strong knowledge of diagnosis code validation, coding guidelines, and documentation standards.Ability to verify the accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation.Ability to identify coding discrepancies and recommend updates based on chart review.Ability to maintain coding accuracy levels greater than 90 percent.Strong communication and collaboration skills when working with vendors, providers, hospital staff, and internal leadership.Ability to work independently with limited direction and exercise sound judgment.Ability to mentor and guide less experienced coding specialists.ExperienceExperience supporting retrospective risk adjustment supplemental filing.Experience supporting HHS-Risk Adjustment Data Validation audit activities.Experience reviewing and coding moderately complex medical records.Experience working with vendors, providers, and hospital staff to coordinate record access.Experience identifying coding discrepancies and supporting quality and provider education initiatives.Experience negotiating agreement on complex medical record diagnoses with leadership and third-party vendors.Experience developing and conducting coding orientation and education for physicians or other healthcare practitioners.Experience developing and maintaining Commercial Risk Adjustment coding guidelines.Experience guiding junior coding specialists on complex chart reviews.ResponsibilitiesPerform medical record review and coding for retrospective risk adjustment supplemental filing, HHS-Risk Adjustment Data Validation audit support, and other chart coding functions.Verify the accuracy, completeness, and appropriateness of diagnosis codes based on medical documentation.Apply appropriate coding guidelines and recommend changes to diagnosis codes based on chart review findings.Achieve and maintain coding accuracy levels greater than 90 percent.Coordinate with vendors, providers, and hospital staff to obtain and manage record access.Identify and document coding observations or discrepancies.Provide findings and recommendations to management to enhance quality and provider education.Work with leadership and third-party vendors to resolve complex medical record diagnosis questions and determine compliance with coding guidelines accepted by the federal government.Develop and conduct coding orientation and education sessions for physicians and other healthcare practitioners.Develop and maintain Commercial Risk Adjustment coding guidelines and update them based on changes in industry standards.Provide guidance and direction to Coding Specialists when reviewing complex medical records.Assist in mentoring less experienced staff and may lead matrixed resources as needed.Plan and manage work independently, escalating only unusual cases when necessary.Should HaveExperience working in a highly regulated healthcare environment.Strong analytical and problem-solving skills.Ability to adapt to changing coding standards and industry requirements.Ability to manage multiple tasks that may take from short-term turnaround to several weeks to resolve.Strong customer service skills with internal and external stakeholders.SkillsRisk adjustment coding.HCC coding.Medical record review.Diagnosis code validation.Chart review.Coding compliance.Coding discrepancy identification.Provider education.Coding guideline development and maintenance.Audit support.Mentoring and guidance.Adobe Acrobat Professional.Microsoft Word.Microsoft Excel.Microsoft Outlook.Claims processing systems.EMR systems.EHR systems.Coding documentation platforms.Customer service and communication.