Medicare Risk Adjust. Coord. (El Paso Health)

Job Summary

Responsible for supporting Medicare risk adjustment program activities including medical record retrieval, documentation analysis, compliance monitoring, and revenue accuracy initiatives within the El Paso Health (EPH) Organization. Collaborates with cross-functional teams to ensure appropriate risk capture, optimize documentation quality, and improve risk adjustment program performance.

Skills

1. Knowledge of CMS, TDI, HHSC, NCQA, and URAC rules and standards to assure compliance.

2. Proficient in the principals of analytical assessment and creative problem solving.

3. Ability to work with risk adjustment analytics tools and methodologies.

4. Strong project management skills. Ability to meet deadlines while producing quality work.

5. Highly organized and detailed oriented.

6. Ability to identify and interpret trends in risk adjustment data.

7. Proficiency in analyzing healthcare data to identify improvement opportunities.

8. Knowledge of Medicare Advantage risk adjustment models (HCC) and CMS guidelines.

9. Knowledge of health plan systems and organizational relationships.

10. Knowledge of Federal laws and regulations affecting coding requirements.

11. Knowledge of medical records and EHR.

12. Excellent verbal and written communication skills. Strong presentation skills

13. Self-starter with the ability to work independently and take initiative.

14. Ability to maintain awareness of changing healthcare industry trends and applications.

Work Experience

Two years of ICD-10 coding, risk adjustment and/or billing experience is required. Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes is required. Strong background in quality improvement and/or chart review is preferred. Experience in an HMO or managed care setting is preferred.

License/Registration/Certification

Coding certification (CPC, CCS-P, CCS-H, RHIT, or CRC) from AHIMA or AAPC is highly preferred.

Education and Training

Bachelor degree in Business Administration, Healthcare Administration or related field is required.