Risk Adjustment Coding Analyst Senior

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

Job summary

HealthPartners in Bloomington, MN, is seeking a Senior Risk Adjustment Coding Analyst to oversee diagnosis coding review and quality assurance, ensuring accurate representation of care needs and risks for plan performance and revenue.

The role requires extensive knowledge of CPT, ICD-9, ICD-10, and revenue cycle processes, plus the ability to train physicians and collaborate with internal teams to improve documentation and coding integrity.

Qualifications

• High School Diploma or GED or Associate’s degree in a related field.
• Four year college degree preferred; CRC or other risk adjustment credentials strongly valued.
• RHIA, RHIT, CPC, CCS, CCS-P certifications required or preferred depending on role.
• CRC certification required for the role.

Responsibilities

• Performs retrospective chart review for diagnosis coding accuracy.
• Identifies, analyzes, and reports coding error trends to inform risk adjustment analytics and provider education.
• Reviews vendor coding and provides feedback and education to vendor team.

Skills

Communication

Team collaboration

Adaptability

Organizational skills

Analytical thinking

Education

High School Diploma or GED or Associate’s degree in a related field

Four year college degree

RHIA/RHIT/CPC/CCS/CCS-P

CRC - Certified Risk Adjustment Coder

Tools

Microsoft Word

Excel

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:

1. Performs retrospective chart review for diagnosis coding accuracy.
2. Identifies, analyzes, and reports coding error trends to inform risk adjustment analytics and deliver provider education.
3. Reviews vendor coding and provide recurring feedback and education to vendor team.
4. Participates in internal and CMS-mandated risk adjustment data validation review.
5. Identifies, documents, and messages process improvements, clinical documentation improvements and/or other educational opportunities.
6. Develops and performs training and educational seminars to physicians and advanced practice providers on risk adjustment topics.
7. Increases collaborative efforts between HealthPartners Health Plan and HealthPartners Medical Group as it relates to optimization of diagnosis coding.
8. Analyzes and organizes complex information for effective reporting to leadership.
9. Conducts daily work consistent with HealthPartners core values and comply with all federal and state regulations.
10. Maintains confidentiality of protected health information.
11. Increases organizational efficiency in daily operations.
12. 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