Risk Adjustment Coding Analyst Senior

HealthPartners; BLOOMINGTON (MN); On-site; USD 85,000 - 120,000; Full time

Job summary

HealthPartners is seeking a Risk Adjustment Coding Analyst Senior to review diagnosis coding and assure accuracy for risk adjustment across our population. You will lead retrospective chart reviews, analyze coding trends, and provide education to physicians and vendors, ensuring compliance with CMS regulations and the HealthPartners data governance standards.

The role emphasizes collaboration with Health Partners Plan and Medical Group to optimize coding and reporting while maintaining PHI

Qualifications

• Minimum five years of diagnosis coding review experience as a certified coder.
• Knowledge of revenue cycle processes, claims processing, retrospective chart reviews, compliance and CPT/ICD-9/ICD-10 coding.
• Ability to identify issues and propose process improvements.
• Experience communicating clinical documentation requirements for accurate coding.
• Proficiency with Microsoft Word and Excel.

Responsibilities

• Performs retrospective chart review for diagnosis coding accuracy.
• Identifies, analyzes and reports coding error trends to inform risk adjustment analytics.
• Reviews vendor coding and provides recurring feedback to the vendor team.
• Participates in internal and CMS-mandated risk adjustment data validation reviews.
• Identifies and documents opportunities for clinical documentation improvements.
• Develops and delivers training on risk adjustment topics to physicians and APPs.
• Collaborates with Health Plan and Medical Group to optimize diagnosis coding.
• Analyses complex data for leadership reporting.
• Maintains confidentiality of protected health information.
• Performs other duties as assigned.

Skills

Diagnosis coding review

CMS risk adjustment

CPT ICD coding

Revenue cycle knowledge

Communication skills

Word & Excel

Epic

Education

High School Diploma or GED

Associate’s degree in related field

Four year college degree

Tools

Epic

Job description

HealthPartners is hiring a Risk Adjustment Coding Analyst Senior.

This position is responsible for diagnosis coding review and vendor coding quality assurance; working to ensure that plan performance and plan revenue is based on an accurate representation of our population’s care needs and risks.

Accountabilities

• Performs retrospective chart review for diagnosis coding accuracy.
• Identifies, analyzes, and reports coding error trends to inform risk adjustment analytics and deliver provider education.
• Reviews vendor coding and provide recurring feedback and education to vendor team.
• Participates in internal and CMS-mandated risk adjustment data validation review.
• Identifies, documents, and messages process improvements, clinical documentation improvements and/or other educational opportunities.
• Develops and performs training and educational seminars to physicians and advanced practice providers on risk adjustment topics.
• Increases collaborative efforts between HealthPartners Health Plan and HealthPartners Medical Group as it relates to optimization of diagnosis coding.
• Analyzes and organizes complex information for effective reporting to leadership.
• Conducts daily work consistent with HealthPartners core values and comply with all federal and state regulations.
• Maintains confidentiality of protected health information.
• Increases organizational efficiency in daily operations.
• Responsible for other duties as assigned.

Required Qualifications

• High School Diploma or GED or Associate’s degree in a related field
• One of the following credentials required: RHIA, RHIT, CPC, CCS, CCS-P
• Certified Risk Adjustment Coder (CRC) credential
• Minimum of five years experience with diagnosis coding review as a certified coder
• Demonstrated working knowledge of the revenue cycle process, claims processing, retrospective chart review process, compliance and federal/state regulations, CPT, ICD-9, and ICD-10 coding
• Identify issues and formulate solutions relating to retrospective chart review process improvement initiatives
• Understand and communicate clinical documentation requirements for correct coding and to ensure integrity of the medical record
• Skill and experience in effectively collaborating with team members & others using oral, written and interpersonal communications
• PC skills in Microsoft Word and Excel
• Organize and prioritize multiple assignments
• Ability to deal with change and ambiguity
• Able to work, both, as a team member or independently

Preferred Qualifications

• Four year college degree
• Experience working with Epic