Ambulatory Risk Adjustment Coding Specialist

NorthShore University HealthSystem; Skokie (IL); On-site; USD 31,000 - 46,000; Full time

Benefits offered by this job

Career growth

Medical, Dental, Vision

Tuition reimbursement

Free parking

Wellness program

HSA options

Retirement with company match

Paid time off

Community involvement

Job summary

Endeavor Health in Skokie, IL seeks an Ambulatory Risk Adjustment Coding Specialist to identify and code HCCs in outpatient visits, ensuring documentation supports CMS risk scores. This role collaborates with ambulatory CDS and physicians to validate codes and improve documentation and coding accuracy.

The position requires a High School diploma, CRC certification within six months, and 2 years in healthcare.

Qualifications

• Education: High School Diploma required; Associates preferred.
• Certifications: CRC required within 6 months of hire.
• Experience: 2 years in healthcare setting.

Responsibilities

• Review/abstract HCC codes to ensure accuracy, highest specificity, and correct CMS-HCC risk score.
• Identify diagnosis and chart level impairments and opportunities for documentation improvement.
• Partner with ambulatory CDS and physicians to code charts for proper risk adjustment.
• Recommend process improvements to coding goals and outcomes.
• Assist onboarding of new coding specialists as needed.
• Maintain knowledge of ICD-10-CM, CMS docs, and regulations.
• Maintain minimum 95% accuracy on coding quality audits.
• Meet productivity requirements per project terms.
• Assign ICD-10-CM codes and assist with risk adjustment.
• Maintain knowledge of all HCC diagnoses per guidelines.
• Assist with special project work from Ambulatory Clinical Documentation Leadership.

Education

High School Diploma

Associates Degree

Job description

Hourly Pay Range

$22.14 - $33.21 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position Highlights

• Position: Ambulatory Risk Adjustment Coding Specialist

• Location: Skokie, IL

• Full Time

• Hours: Monday-Friday, [hours and flexible work schedules]

Brief Overview

Our Ambulatory Risk Adjustment Coding Specialist I plays a key role in identifying HCC codes within physician outpatient visits and ensuring they are coded accurately and to the highest specificity. They additionally will verify that documentation requirements are met to validate the HCC diagnosis code. Working closely with the ambulatory clinical documentation specialist (CDS), they will clinically verify the accuracy of HCC codes. Using compliant query guidelines, the coding specialist will query the physician should documentation need clarification or specification. The coding specialist is expected to maintain current knowledge of the ICD-10-CM codes and guidelines and meet minimum productivity requirements outlined by team leadership.

What you will do

• Review/abstract HCC codes to ensure they are coded accurately, to the highest specificity possible, and make sure the required MEAT is documented, resulting in the correct CMS-HCC risk score

• Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education

• Responsible for partnering with ambulatory clinical documentation specialists and physicians to properly code patient charts to ensure appropriate risk adjustment

• Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes

• Assists the coding team leads with onboarding new coding specialists to the role as needed.

• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations

• Consistently maintain a minimum 95% accuracy on coding quality audits

• Meet minimum productivity requirements as outlined by the project terms

• Utilizes technical coding expertise to assign appropriate ICD-10-CM diagnosis codes, as well as assist in appropriate assignment of risk adjustment

• Maintains advanced knowledge of coding all HCC diagnoses from the medical record in accordance with the ICD-10-CM coding guidelines

• Assists with and completes special project work as assigned by Ambulatory Clinical Documentation Leadership

What you will need

• Education:High School Diploma required, Associates Degree preferred

• Certifications: CRC required within 6 months of hire

• Experience: 2 years experience working in healthcare or professional business environment

Benefits

• Career Pathways to Promote Professional Growth and Development

• Various Medical, Dental, and Vision options

• Tuition Reimbursement

• Free Parking at designated locations

• Wellness Program Savings Plan

• Health Savings Account Options

• Retirement Options with Company Match

• Paid Time Off

• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.