Risk Adjustment Specialist

7 days ago

Brisbane, Queensland, Australia beBeeCoding Full time $105,114 - $155,710

Job Opportunity

This position is responsible for performing chart retrieval, medical record review and analysis to identify health conditions. The candidate will be involved in developing and implementing strategies to improve data quality and reduce risk. They will also oversee the chart review lifecycle from scheduling access to submission of the RAPS file to CMS.

Key Responsibilities
  • Determine adequacy and correctness of physician diagnosis/documentation as it relates to risk adjustment.
  • Proactively identify and implement opportunities for improvement in medical documentation and coding.
  • Develop policies, procedures, operational workflows, auditing worksheets and other documentation to support department processes concerning risk adjustment and RADV activities.
  • Educate and provide feedback to provider offices about medical record documentation and coding issues.
Requirements
  • Associate degree or equivalent combination of education and/or experience.
  • Five years of experience including leadership, medical chart reviews, risk adjustment experience with in-depth knowledge of CPT coding, ICD-9/10, medical terminology and solid understanding of HCC coding.
  • Ability to obtain Certified Risk Adjustment Certification (CRC) from the American Academy of Professional Coders (AAPC) within six months of hire.
Essential Skills
  • Strong attention to detail to determine appropriate health conditions and codes for RADV submissions.
  • Ability to organize and manage time effectively in a fast-paced environment.
  • Maintain current knowledge of regulatory and company policies and procedures.

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