Risk Adjustment Coding Specialist (Remote in New York State)

Capital District Physicians Health Plan Inc; City of Albany (NY); Remote; USD 45,000 - 75,000; Full time

Job summary

Join a compassionate and community-focused health plan that values innovation and quality. As a Risk Adjustment Coding Specialist, you will play a crucial role in ensuring accurate coding and chart review for eligible members. This position offers the opportunity to work in a supportive environment that prioritizes employee engagement and professional growth. With a commitment to diversity and inclusion, you will be part of a team that makes a meaningful impact in the lives of others. If you are detail-oriented and passionate about healthcare, this role is a perfect fit for you.

Benefits

Healthcare coverage

Generous paid time off

Flexible work environment

Employee assistance programs

Qualifications

• Minimum one year of experience in healthcare coding required.
• Strong knowledge of ICD-10 codes and medical terminology essential.
• Ability to handle confidential information appropriately.

Responsibilities

• Responsible for chart review and accurate ICD-10 coding.
• Review medical records to identify diagnosis codes.
• Engage in diagnosis code projects as needed.

Skills

ICD-10 diagnosis coding

Medical terminology

Anatomy and physiology knowledge

Microsoft Office proficiency

Customer service skills

Attention to detail

Problem-solving skills

Education

High school diploma or GED

Associate's degree

CCS/CCS-P or CPC/CPC-A certification

CRC credential

Tools

ICD-10-CM code book

Claims adjudication systems

Billing systems

Job description

Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a holistic approach to diversity, equity, and inclusion. At CDPHP, employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be part of that experience.

The Risk Adjustment Coding Specialist will be responsible for chart review and ICD-10 diagnosis coding of risk adjustment eligible members. This position involves reviewing medical records to identify accurate ICD-10 diagnosis codes, chart retrieval activities, and occasional diagnosis code projects.

QUALIFICATIONS:

• High school diploma or GED required; Associate's degree preferred.
• CCS/CCS-P (Certified Coding Specialist) or CPC/CPC-A (Certified Coding Professional) required. If CCA or RN/LPN licensure, successful completion of AHIMA CCS/CCS-P or AAPC CPC certification within one year of employment is required.
• CRC (Certified Risk Adjustment Coder) credential preferred.
• Minimum one (1) year of experience in an HMO, Managed Care Organization, or healthcare setting required.
• Strong knowledge of medical terminology, anatomy, physiology, and medical chart review required.
• Knowledge of ICD-10 diagnosis and procedure codes, CPT codes, Revenue codes, and HCPCS codes required.
• Experience coding with ICD-10-CM code book (without encoder software) required.
• Working knowledge of HIPAA requirements, recognizing commitment to privacy, security, and confidentiality of medical charts and patient information required.
• Chronic Conditions knowledge preferred.
• Experience in claims adjudication, billing, enrollment systems, product or pricing preferred.
• Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint) required.
• Experience with Clinical Documentation Improvement preferred.

• Demonstrated knowledge of medical record review and diagnosis coding within the health insurance industry.
• Ability to research, analyze, interpret CMS and State coding guidelines, and apply to chart review, coding, and auditing.
• Proactive problem identification and solution implementation skills.
• Excellent customer service and relationship-building skills internally and externally.
• Ability to handle confidential information appropriately.
• Excellent verbal and written communication skills.
• Flexibility to adapt to a fast-paced, changing environment.
• Strong organizational and planning skills.
• Attention to detail and thoroughness.
• Successful remote work experience without direct supervision.

CDPHP offers competitive salary ranges with opportunities for professional and financial growth. Compensation is based on experience, qualifications, and skills. Employees may be eligible for incentive payments, discretionary cash rewards, and overtime pay. The comprehensive benefits package includes healthcare coverage, health care dollars, generous paid time off, employee assistance programs, flexible work environment, and more. Learn about all benefits at https://www.cdphp.com/about-us/jobs/benefits.

As an Equal Opportunity / Affirmative Action Employer, CDPHP does not discriminate based on race, color, creed, religion, sex, sexual orientation, gender identity or expression, age, national origin, marital status, disability, or other protected characteristics. All qualified applicants will receive consideration without regard to these factors. CDPHP and its subsidiaries include SSMC, PSS, and ConnectRx Services, LLC.