Risk Adjustment Coder (STX)

Prominence Health; McAllen (TX); On-site; USD 60,000 - 78,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive Compensation

Generous Paid Time Off

Excellent Medical, Dental, Vision and

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health seeks a skilled Coder of Risk Adjustment to ensure accurate, compliant coding and documentation review supporting Medicare risk adjustment and organizational compliance. The coder performs post-review production coding, medical record abstraction for HEDIS data, and chart preparation for scheduled health assessments, guiding coding requirements for provider reviews.

This is an onsite position. Knowledge of HEDIS data collection is required.

Qualifications

• Minimum 1 year experience in CMS HCC risk adjustment coding.
• Successful completion of coding certification program (CCS, CPC, CRC, or RHIT).
• ICD-10 and CPT II coding proficiency required.

Responsibilities

• Code Medicare risk adjustment accuracy and compliance.
• Perform post-review production coding and medical record abstraction for HEDIS data collection.
• Identify documentation and coding opportunities for provider review.
• Prepare charts for scheduled health assessments and guide coding/documentation requirements.

Skills

CMS HCC coding

ICD-10 CPT II

Professional coding certification

English communication

Microsoft Office

Education

High School Diploma or GED

Associates degree preferred

Tools

Microsoft Office Suite

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary

The Coder of Risk Adjustment will be responsible for accurate, compliant coding and documentation review to support Medicare risk adjustment and organizational compliance. The Coder performs post review production coding, medical record review abstraction in support of the Healthcare Effectiveness Data and Information Set (HEDIS) data collection. The role also includes preparing charts for scheduled health assessments, identifying documentation and coding opportunities for provider review, and providing guidance on coding and guidance on coding and documentation requirements related to those charts. The Coder must be well grounded in sound medical coding practices. Knowledge of HEDIS data collection is required. This is an onsite position.

Benefit Highlights

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications and Requirements

• High School Diploma, GED or equivalent required; Associates degree preferred
• Minimum one (1) year experience in CMS HCC risk adjustment coding required
• Successful completion of coding certification program (CCS, CPC, CRC, or RHIT)
• ICD-10 and CPT II coding proficiency
• Must have the ability to meet 95% & above accuracy
• Must have the ability to meet CPH expectations
• Ability to effectively communicate in English, both verbally and in writing.
• Proficient in Microsoft Office Suite, Word, Excel and Access
• Excellent written and oral communication skills
• Attention to the detail.
• Must have the ability to work independently
• Insurance industry. Knowledge of HEDIS data collection is preferred.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.