Risk Adjustment Coding and Documentation Specialist - remote eligible

Kootenai Health; Coeur d'Alene (ID); Remote; USD 70,000 - 90,000; Full time

Job summary

Kootenai Health seeks a Risk Adjustment Coding and Documentation Specialist for a remote-eligible role, with travel to Coeur d'Alene, ID 2–4 times yearly. You will improve diagnosis coding quality, educate clinicians, and collaborate with payer partners to optimize coding strategies while supporting care quality initiatives.

Ideal candidates have formal coding training, 3+ years of coding/medical records review, AHIMA/AAPC credentials, and CDEO certification within 12 months.

Qualifications

• Graduate of a formal coding program or completion of a coding training course required.
• Associate degree preferred.
• Minimum 3 years' coding/medical record chart review experience in a healthcare setting required.
• Previous Risk Adjustment Methodology and diagnosis coding experience required.
• Coding certifications through AHIMA or AAPC (CCS, CPC, CCS-P) or similar required.
• CDEO certification required within 12 months of hire.
• HCC knowledge/diagnosis coding experience preferred.

Responsibilities

• Verifies accuracy, completeness, specificity, and appropriateness of risk-adjusted codes and documentation.
• Educates clinicians and staff on pre-visit planning and illness severity.
• Provides regular feedback on coded cases and documentation opportunities.
• Analyzes chart documentation related to clinical status and treatment history; identifies gaps.
• Educates staff by identifying coding errors to improve network value.
• Develops program improvement plans and training materials.
• Educates on solutions per nationally recognized coding guidelines.
• Collaborates with payer partners on coding recapture and resolution.
• Utilizes population health tools to track and report diagnosis coding information.
• Collaborates with contracting, analytics and IT to implement data/report improvements.
• Performs other duties; maintains regular attendance and age-appropriate care.

Skills

CPT & ICD-10 knowledge

Project management

Clinical documentation education

Written & verbal communication

Education of clinicians

Education

Formal coding program/coding training

Associate degree preferred

AHIMA/AAPC certifications (CCS, CPC, CCS-P)

CDEO certification within 12 months

HCC knowledge/experience preferred

Job description

Risk Adjustment Coding and Documentation Specialist - remote eligible

• Facility Kootenai Care Network
• Department Kootenai Care Network
• Schedule/Shift/Hours Full Time - Days - Remote Eligible

This position is US-Remote Eligible. Currently,KootenaiHealth employees cannot be located in: California, Hawaii, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Rhode Island, Vermont, Washington D.C., West Virginia, or Wyoming. This list is continuously evolving and may be updated.

Travel to our main campus in Coeur d'Alene, Idaho requiredapproximately 2-4 times annually.

Position Summary

This position is responsible for facilitating the improvement in the overall quality, completeness, and accuracy of practice-based clinical diagnosis coding and documentation.

Responsibilities

• Verifies and ensures the accuracy, completeness, specificity, and appropriateness of risk adjustable diagnosis codes and clinical documentation based on services rendered
• Engages KCN clinicians and their staff by supporting and educating on pre-visit planning to include identifying severity of patient illness
• Improves the provider coding experience by ensuring KCN clinicians and their staff receive regular feedback regarding coded cases and opportunities for improved documentation
• Supports KCN practices by analyzing chart documentation related to clinical status of patient, current treatment plan, past medical history and identifies potential gaps in provider documentation
• Serves as a resource by independently educating KCN clinicians and their staff by identifying errors and issues related to diagnosis coding and documentation to bring about a positive network value program outcome
• Develops program improvement plans and training materials
• Suggests and educates appropriate solutions in accordance with nationally recognized coding guidelines
• Actively engages and collaborates with payer partners on coding recapture and resolution of diagnosis
• Utilizes software and population health application to collect, track, and communicate information related to diagnosis coding
• Collaborates with KCN Contracting, Analytics and Information System teams to discern appropriate interventions for identified performance opportunities through enhancements or optimization to data, reports and population health application
• Performs other related duties as assigned
• Familiar with standard concepts, practices, and procedures within the fieldRelies on experience and judgment to plan and accomplish goals
• Regular and predictable attendance is an essential job function
• Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

• Graduate of a formal coding program or completion of a coding training course required
• Associate degree preferred
• Minimum 3 years' coding/medical record chart review experience in a healthcare setting required
• Previous Risk Adjustment Methodology and diagnosis coding experience required
• Coding certifications through AHIMA or AAPC; Outpatient Coding: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician, (CCS-P), or other related certification required
• Clinical Documentations Expert Outpatient (CDEO) certification required within 12 months of hire
• Certification as Risk Adjustment Coder preferred
• Experience with Hierarchical Coding Category (HCC) Risk Adjustment Model preferred
• HCC diagnosis coding and clinical record(s) review process preferred
• Strong knowledge of CPT and ICD-10 coding and medical record documentation
• Proven history of project management and/or coordinating detailed projects or activities
• Strong written and verbal communication skills, including ability to establish and build strong relationships

Working Conditions

• Must be able to lift and move up to 10lbs
• Must be able to maintain a sitting position
• Typical equipment used in an office job
• Repetitive movements

About Kootenai Health

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

As your next employer, we are excited to offer you:

• Comprehensive medical coverage, including fully employer‑paid options for eligible full‑time employees, plus affordable plans for part‑time staff.Benefits begin on the 1st of the month following 30 days of employment.
• Dental, vision, life, and pet insurance, with telemedicine and wellbeing resources available to all employees
• Tuition assistance after 90 days to support your professional growth
• Retirement plans with pre‑tax and Roth options and employer matching from 3%–6%
• Competitive pay, plus night, weekend, and PRN shift differentials
• Award‑winning wellness program with coaching, financial wellness resources, and free or discounted access to fitness centers and premium wellbeing apps
• PerkSpot discountsproviding access to thousands of exclusive deals in over 25 categories
• And an employee referral bonus program

Kootenai Health provides exceptional support for extraordinary careers. If you want to work on a high-quality, person-centered healthcare team, we can't wait to meet you!

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.

A variety of medical, dental, and vision insurance plans are available to both full and part-time employees, with some available at no cost to the employee. In addition, benefit-eligible employees also gain access to the following:

• Tuition assistance and career development programs
• Robust Retirement Plan
• Night, weekend and PRN shift differentials
• Employee referral bonus program

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