Senior Risk Adjustment Medical Coder - CRC Remote

AAPC; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

HealthPartners is seeking a Senior Risk Adjustment Coding Analyst to lead retrospective chart reviews for diagnosis coding accuracy and to ensure accurate representation of population risk for plan performance.

The role includes reviewing vendor coding, delivering education to providers, supporting CMS data validation, and driving process improvements across the risk adjustment workflow while protecting patient information and complying with regulations.

Qualifications

• Five years of diagnosis coding review as a certified coder.
• Knowledge of CPT, ICD-9, ICD-10 and revenue cycle processes.
• Identify issues and drive retrospective chart review improvements.
• Understand clinical documentation requirements for correct coding.
• Strong communication and team collaboration skills.

Responsibilities

• Performs retrospective chart review for diagnosis coding accuracy.
• Identifies, analyzes, and reports coding error trends to inform risk adjustment analytics and education.
• Reviews vendor coding and provides feedback to vendor team.
• Participates in CMS risk adjustment data validation review.
• Develops training and educational seminars on risk adjustment topics.
• Collaborates with Health Partners Health Plan and Medical Group on coding optimization.
• Analyzes complex information for leadership reporting.
• Maintains confidentiality and compliance with regulations.
• Increases organizational efficiency in daily operations.
• Responsible for other duties as assigned.

Skills

Risk adjustment coding

Communication

Organizational skills

Team collaboration

Adaptability

Education

RHIA

RHIT

CPC

CCS

CCS-P

CRC

Four year college degree

Associate's degree in related field

Tools

Microsoft Word

Excel

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 provides 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 complies 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