RISK ADJUSTMENT CODING SPECIALIST

Covenant HealthCare; Saginaw (MI); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Retirement plan with employer match

Paid time off

Job summary

Covenant HealthCare Partners seeks a Risk Adjustment Coding Specialist to ensure accurate documentation and coding for HCC capture across providers. You will review charts, educate clinicians, and support audit processes to improve documentation quality and revenue alignment.

You will collaborate closely with the HCC Coding Auditor Educator and CHP leadership, contributing to ongoing coding performance analysis and physician engagement across network sites.

Qualifications

• Associates degree is required; bachelor’s preferred.
• CPC or CRC certification required; may substitute two years ICD9/10CM/CPT-4 coding experience with CPC within 12 months.
• Experience in professional coding setting/physician office preferred.
• Familiarity with Epic or similar EHR documentation methodologies.

Responsibilities

• Compile payer and Epic data related to risk coding and documentation performance.
• Adhere to coding rules to ensure quality coding based on documentation.
• Identify opportunities to improve coding accuracy through chart and report review.
• Query providers to address documentation reassessment opportunities for higher accuracy and specificity.
• Educate providers and staff on processes for improving coding accuracy and HCC performance.
• Assist in preparing presentations for CHP leadership and physician meetings.
• Participate in risk adjustment team meetings and process improvement projects.

Skills

Communication skills

HIPAA compliance

Microsoft Office

Professional coding knowledge

Relationship building

Education

Associates degree

Bachelor’s degree preferred

CPC or CRC certification

Tools

Epic EMR

Systoc

IntelliCode

AAPC

Job description

Overview

As an integral member of the Covenant HealthCare Partners team, the Risk Adjustment Coding Specialist shared accountability for ensuring the providers of CHP are documenting and coding conditions in accordance to the CHP standard. This role will assist the HCC Coding Auditor Educator with provider education and subsequently improve documentation across HCC coding, providing increased revenue to help meet our mission of providing extraordinary care to every generation.

The Risk Adjustment Coding Specialist will review performance metrics and reports, as well as patient charts, to identify areas of opportunity to support effective documentation practices, coding accuracy, and coding persistency. This position will assist in educating all primary and specialty care providers and other clinical staff on processes for improving coding accuracy performance, proper documentation, and improved HCC performance in coding specificity and persistency to fully capture the risk of our population.

HCC Coding Specialist demonstrates excellent customer service performance in attitude and actions that are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant Healthcare and the commitment to Extraordinary Care for Every Generation.

Responsibilities

• Compile payer data as well as Epic data related to risk coding and documentation performance.
• Adhere to coding rules for coding professional to ensure quality coding based upon documentation within the patient record.
• Follows policies, procedures and guidelines to assure consistent coding quality. At the same time utilizes analytical skills when reviewing charts, interpreting documentation and applying codes, sufficing edits, etc.
• Assist in the Identification of opportunities to improve coding accuracy through chart review and report review.
• Review charts and query provider(s) to address documentation reassessment opportunities to prompt higher accuracy and or/or specificity.
• Identify pre- and post-encounter opportunities for HCC Coding Auditor Educator and assist as needed in physician meetings.
• Special projects as assigned for HCC analytics.
• Assist in preparing presentations and materials for coding performance and opportunities to CHP leadership and the general physician membership at Medical Management Group meetings.
• Participate in the work of the risk adjustment team.
• Participate in process improvement activities and assist in the creation of coding support tools for CHP physicians.
• Demonstrate ability to appropriately use coding principles that comply with CMS regulations and CHP/Covenant goals and policies.
• Ensure compliance with established coding guidelines, third party reimbursement policies, regulations, and accreditation guidelines.
• Work with all payers to meet audit/documentation requirements.
• Assists in providing direct and timely response to compliance audit plan results.
• Formulates and uses effective working relationships with all members of the department, physicians, external customers, patients and other staff members of departments encountered.
• Participates in department meetings and area specific meetings (Professional coding, Practice Managers, billing, routine specialty, clinical areas, resident/physician meetings, etc.) as required.
• Independent learning with desire for continued personal and professional growth. Stays current on coding updates and publications.
• Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed.
• Maintains professional credentials.
• Perform other duties as assigned.

Qualifications

• EDUCATION/EXPERIENCE
• Associates degree required, bachelor's degree preferred.
• Professional coding certification (CPC, CRC) required. Candidate may substitute two (2) years ICD9/10CM and CPT-4 coding experience with understanding that the Certified Professional Coder (CPC) requirement be fulfilled within 12 months of hire.
• Experience in professional coding setting/physician office setting preferred.
• KNOWLEDGE/SKILLS/ABILITIES
• Familiarity with electronic health records (preferably Epic, Intelicode, Systoc, AAPC, etc) documentation methodologies.
• Knowledge/understanding of medical terminology and anatomy.
• Knowledge of third party payer coding and billing reimbursement.
• Knowledge of ICD9/10CM diagnosis coding, CPT-4 coding and HCPCS coding guidelines.
• Demonstrated achievement with change management and quality improvement initiatives.
• Proven success in building relationships and established credibility with doctors, nurses, and other clinical staff.
• Exceptional communication and interpersonal skills.
• Proficiency in Microsoft Office products.
• Ability to navigate resistance to change and solve problems effectively.
• Ability to travel to physician offices within the CHP network.
• Ability to remain calm and courteous in stressful/difficult situations.
• Ability to maintain confidential information and comply with HIPAA standards.
• WORKING CONDITIONS/PHYSICAL DEMANDS
• Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.
• Constant sitting, use of hands to finger, handle and feel.
• Constant hearing and near vision.
• Frequent depth perception, midrange and far vision.
• Frequent color and field of vision.
• Frequent lifting 0-10 lbs.
• Occasional lifting 11-50 lbs.
• Occasional standing, walking, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting and crawling.
• Occasional twisting, reaching and talking.

Why Work at Covenant HealthCare

At Covenant HealthCare, we are united by a shared mission of providing Extraordinary Care for Every Generation. We foster a culture built on teamwork, excellence, accountability, respect, customer service, and enthusiasm, where every employee plays an important role in delivering patient-centered care and making a difference in our community.

Our benefits include:

• Comprehensive medical, dental, and vision coverage
• Retirement plans with employer match
• Paid time offto support work-life balance
• Employee wellness programs and mental health support
• Tuition reimbursement, university discounts, and professional development opportunities