Senior Risk Adjustment Coding & QA Specialist

HealthPartners; BLOOMINGTON (MN); On-site; USD 85,000 - 120,000; Full time

Job summary

HealthPartners is seeking a Risk Adjustment Coding Analyst Senior to review diagnosis coding and assure accuracy for risk adjustment across our population. You will lead retrospective chart reviews, analyze coding trends, and provide education to physicians and vendors, ensuring compliance with CMS regulations and the HealthPartners data governance standards.

The role emphasizes collaboration with Health Partners Plan and Medical Group to optimize coding and reporting while maintaining PHI

Qualifications

• Minimum five years of diagnosis coding review experience as a certified coder.
• Knowledge of revenue cycle processes, claims processing, retrospective chart reviews, compliance and CPT/ICD-9/ICD-10 coding.
• Ability to identify issues and propose process improvements.
• Experience communicating clinical documentation requirements for accurate coding.
• Proficiency with Microsoft Word and Excel.

Responsibilities

• Performs retrospective chart review for diagnosis coding accuracy.
• Identifies, analyzes and reports coding error trends to inform risk adjustment analytics.
• Reviews vendor coding and provides recurring feedback to the vendor team.
• Participates in internal and CMS-mandated risk adjustment data validation reviews.
• Identifies and documents opportunities for clinical documentation improvements.
• Develops and delivers training on risk adjustment topics to physicians and APPs.
• Collaborates with Health Plan and Medical Group to optimize diagnosis coding.
• Analyses complex data for leadership reporting.
• Maintains confidentiality of protected health information.
• Performs other duties as assigned.

Skills

Diagnosis coding review

CMS risk adjustment

CPT ICD coding

Revenue cycle knowledge

Communication skills

Word & Excel

Epic

Education

High School Diploma or GED

Associate’s degree in related field

Four year college degree

Tools

Epic

Job description

HealthPartners is seeking a Risk Adjustment Coding Analyst Senior to review diagnosis coding and assure accuracy for risk adjustment across our population. You will lead retrospective chart reviews, analyze coding trends, and provide education to physicians and vendors, ensuring compliance with CMS regulations and the HealthPartners data governance standards.

The role emphasizes collaboration with Health Partners Plan and Medical Group to optimize coding and reporting while maintaining PHI