Senior Coder, Risk Adjustment

Prominence Health; Reno (NV); On-site; USD 77,000 - 110,000; Full time

Job summary

Prominence Health is seeking a Senior Coder to perform documentation and coding reviews for services rendered across partnered practices. You will ensure accurate diagnoses and service codes to support risk adjustment and quality measurement, with pre, post, and wraparound input. Some onsite work and occasional travel may be involved.

Strong CMS coding knowledge, HCC experience, and EMR proficiency are essential. Bilingual Spanish is a plus, and CRC/AHIMA credentials are preferred.

Qualifications

• Requires CMS coding knowledge and HCC risk adjustment experience.
• Experience with diverse EMR systems and documentation guidelines.
• CRC certification and AHIMA/APCP credentials preferred.

Responsibilities

• Oversee documentation and coding review of medical records for risk adjustment and quality metrics.
• Collaborate with provider offices to ensure accurate reporting of diagnoses and service codes.
• Occasionally work onsite at provider offices; may require travel for training.

Skills

CMS coding

HCC risk adjustment

EMR navigation

English proficiency

Analytical skills

Spanish language

Education

Bachelor degree or equivalent in medical records/billing

CRC Certification

Tools

MS Office Suite

EMR systems

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Job Summary:

The Senior Coder is responsible for documentation and coding review of medical records where services are rendered at various partnered medical practices. Will work with assigned provider offices to ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work will include pre, post and wraparound visit input. The Senior Coder will be required to work occasionally onsite at the provider office and may require travel to out of state for in person provider education and training. The Senior Coder will be required to maintain consistent and reliable methods of communication to accommodate the hours and demands of providers’ schedules.

Learn more at: https://prominence-health.com/

Benefit Highlights

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications

• University/college degree, or equivalent medical records, claims or billing experience
• 3+ years in CMS coding and documentation guidelines as well as HCC risk adjustment coding practices
• CRC Required.
• Additional Coding certification preferred (CCS, CPC, or RHIT) Must be credentialed through AAPC or AHIMA.
• 2+ years in Risk Adjustment Coding
• Experience working in a variety of EMRs and the ability to navigate and pick up EMR applications agree
• Strong understanding and knowledge of CMS Coding and Documentation Guidelines agree
• Demonstrated competency in HCC coding practices. agree
• Proficient with MS Office Suite (Word, Excel, Outlook), Internet and databases agree
• Knowledge of age-specific needs and elements of disease processes and related procedures required.
• Strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes.
• Working knowledge of inpatient admission criteria, Medicare reimbursement system and coding systems preferred, but not required.
• Previous medical office experience preferred.
• Ability to read and write effectively in English; bi-lingual Spanish preferred
• Highly organized, proficient critical-thinking and analytical problem-solving skills
• May be required to be available beyond normal 8-5 working hours, including weekends, to accommodate office and provider hours) and to work occasionally onsite at a provider’s office
• Ability to work independently in a time oriented environment is essential.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.