Risk Adjustment Specialist

Triton Health Systems; Birmingham (AL); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health coverage

401(k) plan

PTO

Holidays

Tuition assistance

Flexible Spending Accounts

Life Insurance

Job summary

VIVA HEALTH, part of the UAB Health System, seeks a Risk Adjustment Specialist in Birmingham, AL. You will document ICD-10 codes to assign valid HCCs for CMS submissions and review suspect reports to capture unreported diagnoses.

Responsibilities include chart audits of in-house records and supporting the Risk Adjustment Manager on special projects; strong coding knowledge and communication skills are essential.

Qualifications

• Excellent oral and written communications skills.
• Ability to work under pressure to meet deadlines.
• Basic computer skills and familiarity with documentation systems.
• Ability to read handwritten and typewritten material.

Responsibilities

• Document ICD-10 codes to ensure valid CMS HCCs.
• Review suspect reports to identify unreported diagnosis codes.
• Conduct chart audits on in-house records for accuracy.
• Assist the Risk Adjustment Manager with other projects as needed.

Skills

Communication skills

Pressure tolerance

Computer literacy

Reading/Interpretation

Education

High School Diploma or GED

Certified Coder (AHIMA or AAPC)

Job description

Location: Birmingham, Alabama

Job Summary

The Risk Adjustment Specialist ensures all ICD-10 codes are documented for the assignment of valid and accurate HCCs for each record reviewed for submission to the Centers for Medicare & Medicaid Services (CMS). Other responsibilities include working suspect reports to identify unreported diagnosis codes and conducting chart audits on in-house records from other departments. This position will assist the Manager of Risk Adjustment with other projects as needed.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Maintain thorough understanding of the risk-adjusted payment methodology; what can be submitted by the plan and how/when submission impacts CMS payments.
• Demonstrate knowledge of ICD10 coding guidelines, medical terminology, disease processes, and pharmacology.
• Interpret and demonstrate analytical and problem-solving ability in reviewing medical record documentation to accurately assign ICD10 codes.
• Conduct chart reviews to identify all appropriate diagnoses based on CMS-HCCs and specific HEDIS measures.

REQUIRED QUALIFICATIONS:

• High School Diploma or GED
• At least 3-5 years' experience with coding
• Certified Coder (AHIMA or AAPC credentials)
• Read and interpret handwritten and typewritten material
• Excellent oral and written communications skills
• Ability to work under pressure to meet deadlines with minimal supervision
• Basic computer skills

PREFERRED QUALIFICATIONS:

• 2 or more years of college
• Experience with hospital coding

Equal Opportunity Employer
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