Risk Adjustment Coding Specialist II (Houston, TX)

Job Description

Description

We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry.

*Requires travel to provider sites in surrounding areas

*May be open to considering Level I Specialists based on experience and skills

Our Values:

Put Patients First

Empower Entrepreneurial Provider and Care Teams

Operate with Integrity & Excellence

Be Innovative

Work As One Team

What You'll Do

Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company

Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)

Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines

Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation

Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing

Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.

Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.

Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.

Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.

May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I

Qualifications

Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Coding Specialist (CCS-P), CCS, or CPC.

3-5+ years of experience in risk adjustment coding and/or billing experience required

Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time, if applicable.

PC skills and experience using Microsoft applications such as Word, Excel, and Outlook

Excellent presentation, verbal and written communication skills, and ability to collaborate

Must possess the ability to educate and train provider office staff members

Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.

You're great for this role if:

Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC

Certified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experience

Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage

Strong PowerPoint and public speaking experience

Ability to work independently and collaborate in a team setting

Experience with Monday.com

Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

Environmental Job Requirements and Working Conditions

Our organization follows a hybrid work structure where the expectation is to work both in provider offices and at home on a weekly basis. This position will require up to 75% travel to provider offices in the surrounding areas in Connecticut. The home office is located at 19500 TX-249, Suite 570, Houston, TX 77070. Any time you are not traveling will be remote work.

The work hours are Monday through Friday, standard business hours.

The total pay range for this role is: $70,000 - $85,000 per year. This salary range represents our national target range for this role.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Full-time

Hybrid remote