About this role
Job Description Summary Under the direction of Burden of Illness department leadership, the Risk Adjustment Coding Specialist is responsible for various aspects of decision-making and coding reviews to facilitate, obtain, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect the severity of illness and complexity of patient care. How will you make an impact & Requirements Responsibilities
• Perform prospective medical record reviews for clinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter.
• Review the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission to validate completeness and accuracy of provider selected ICD-10-CM codes.
• Collaborate with healthcare providers and other stakeholders to clarify documentation and ensure accurate coding and reporting of diagnoses.
• Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.
• Participate in coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.
• Stays current on applicable coding and documentation guideline changes and rules.
• This role is expected to maintain a consistent accuracy rate of 95% or higher and able to meet productivity standards established by leadership.
• Abstract and assign ICD-10-CM diagnosis codes supported in the encounter documentation not initially assigned to the encounter claim following ICD-10-CM Official Guidelines for Coding and Reporting.
• Conduct retrospective audits of medical records to validate the accuracy and completeness of diagnosis coding and claim submission, identifying and resolving any discrepancies or areas for improvement.
• Perform comprehensive reviews of provider actions within the Value Based Alert Tool (VBAT) to identify outliers and areas of opportunity.
• Analyze MRA data to identify patterns and when requested assist in the development of interventions at the provider and region level.
• Keeps department leadership appraised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
Compensation: $22.00to $33.00