Risk Adjustment Coding Specialist

2 weeks ago

Cleveland, Queensland, Australia beBeeCoding Full time $41,440 - $98,320
Job Summary

We are seeking a highly skilled Coding Specialist to join our team. The successful candidate will be responsible for performing medical record reviews, risk adjustment experience with in-depth knowledge of CPT coding, ICD-9/10, medical terminology, and solid understanding of HCC coding.


About the Role

The Coding Specialist will oversee the chart review lifecycle from scheduling access, collecting images, coding chart data, developing the supplemental record, and submission of the RAPS file to CMS. They will also determine adequacy and correctness of physician diagnosis/documentation as it relates to risk adjustment.


Main Responsibilities
  • Oversee the chart review lifecycle including scheduling access, image collection, chart data coding, supplemental record development, and RAPS file submission.
  • Determine adequacy and correctness of physician diagnosis/documentation related to risk adjustment.
  • Serve as a resource for quality coding per guidelines and supervise internal and external coders.
  • Develop policies, procedures, operational workflows, auditing worksheets, and other documentation to support department processes concerning risk adjustment, risk mitigation, and RADV activities.
  • Perform periodic audits of revenue realization activities and implement quality oversight on the retrospective chart review process, home visits, and bidirectional reviews.
  • Educate and provide feedback to provider offices about medical record documentation and coding issues to facilitate accurate claims submissions and reduce RADV risk exposure.

Required Skills and Qualifications
  • Associate degree or equivalent combination of education and/or experience.
  • Five (5) 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.

Benefits

We offer a competitive benefits package including medical, dental, vision, life insurance, paid time off, and other benefits.


Other Information
  • Ability to obtain Certified Risk Adjustment Certification (CRC) from the American Academy of Professional Coders (AAPC) within 6 months of hire.
  • Demonstrated knowledge of Microsoft Office and software for electronic processing of medical records.
  • Up-to-date knowledge on risk adjustment HCC processing concerning ICD-9/10 coding guidelines.

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