Senior Risk Adjustment Medical Coder - CRC

DaMar Staffing; BLOOMINGTON (MN); On-site; USD 85,000 - 110,000; Full time

Job summary

HealthPartners in Minnesota is seeking a Risk Adjustment Coding Analyst Senior to review diagnosis coding and oversee vendor coding quality assurance. The role ensures that plan performance and revenue reflect the population's care needs and risks.

The position requires strong chart review skills, knowledge of CPT/ICD coding, and experience with revenue cycle processes. Collaboration with providers and vendors is essential to maintain compliant coding practices.

Qualifications

• Minimum: certified coder with CRC or RHIA/RHIT/CPC/CCS/CCS-P credential.
• Minimum five years of diagnosis coding review experience.
• Knowledge of CPT, ICD-9 and ICD-10 coding and revenue cycle processes.
• Ability to communicate clinical documentation requirements clearly.
• Ability to organize, prioritize multiple assignments and adapt to change.

Responsibilities

• Perform retrospective chart reviews for coding accuracy.
• Identify and report coding error trends to inform risk adjustment analytics.
• Review vendor coding and provide feedback and education.
• Participate in data validation reviews for risk adjustment.
• Develop training materials and seminars on risk adjustment topics.
• Collaborate with HealthPlan and Medical Group on coding optimization.
• Prepare information for leadership reporting.
• Maintain confidentiality of protected health information.

Skills

Retrospective chart review

Coding accuracy

Issue identification & solutions

Communication

Education delivery

Team collaboration

Regulatory compliance

Microsoft Word

Excel

Education

High School Diploma or GED or Associate degree

Four year college degree

Tools

Epic

Job description

Job Description

HealthPartners is hiring a Risk Adjustment Coding Analyst Senior.

This position is responsible for diagnosis coding review and vendor coding quality assurance; working to ensure that plan performance and plan revenue is based on an accurate representation of our population's care needs and risks.

ACCOUNTABILITIES:

1. Performs retrospective chart review for diagnosis coding accuracy.
2. Identifies, analyzes, and reports coding error trends to inform risk adjustment analytics and deliver provider education.
3. Reviews vendor coding and provide recurring feedback and education to vendor team.
4. Participates in internal and CMS-mandated risk adjustment data validation review.
5. Identifies, documents, and messages process improvements, clinical documentation improvements and/or other educational opportunities.
6. Develops and performs training and educational seminars to physicians and advanced practice providers on risk adjustment topics.
7. Increases collaborative efforts between HealthPartners Health Plan and HealthPartners Medical Group as it relates to optimization of diagnosis coding.
8. Analyzes and organizes complex information for effective reporting to leadership.
9. Conducts daily work consistent with HealthPartners core values and comply with all federal and state regulations.
10. Maintains confidentiality of protected health information.
11. Increases organizational efficiency in daily operations.
12. Responsible for other duties as assigned.

REQUIRED QUALIFICATIONS:

• High School Diploma or GED or Associate's degree in a related field
• One of the following credentials required: RHIA, RHIT, CPC, CCS, CCS-P
• Certified Risk Adjustment Coder (CRC) credential
• Minimum of five years experience with diagnosis coding review as a certified coder
• Demonstrated working knowledge of the revenue cycle process, claims processing, retrospective chart review process, compliance and federal/state regulations, CPT, ICD-9, and ICD-10 coding
• Identify issues and formulate solutions relating to retrospective chart review process improvement initiatives
• Understand and communicate clinical documentation requirements for correct coding and to ensure integrity of the medical record
• Skill and experience in effectively collaborating with team members & others using oral, written and interpersonal communications
• PC skills in Microsoft Word and Excel
• Organize and prioritize multiple assignments
• Ability to deal with change and ambiguity
• Able to work, both, as a team member or independently

PREFERRED QUALIFICATIONS:

• Four year college degree
• Experience working with Epic