Sr Risk Adjustment Coding Specialist

Community Health Plan of Washington; Seattle (WA); Remote; USD 60,000 - 100,000; Full time

Job summary

Join a dedicated team as a Risk Adjustment Coding Specialist, where you will play a vital role in enhancing healthcare quality. This position offers the chance to support coding guidelines, conduct audits, and lead quality assurance processes. With a focus on professional growth, you will engage in meaningful work that directly impacts community health. Enjoy competitive compensation and a comprehensive benefits package, including generous PTO, insurance, and a remote work stipend. If you're passionate about healthcare and coding, this opportunity is perfect for you!

Benefits

Medical, dental, and vision insurance

401(k) retirement benefits

17 days of PTO

40 hours of community service for volunteer time

Monthly stipend for work-from-home expenses

Two floating holidays

Qualifications

• 5+ years of experience in diagnosis coding and audits.
• AHIMA CCS or AAPC CPC/H Coding Certification required.

Responsibilities

• Maintain coding guidelines and ensure compliance with regulations.
• Lead risk adjustment coding and quality assurance processes.

Skills

Strong written and verbal communication skills

Strong analytical skills

Ability to multi-task

Strong organizational and time management skills

Education

Bachelor’s degree or equivalent experience

Tools

EMR software

Microsoft Office products

Job description

Prospective candidates for this Risk Adjustment Coding Specialist position with employer would have the opportunity to work with a team of dedicated professionals and contribute to the company's mission of improving healthcare quality for its members. The employer offers competitive compensation and benefits packages, as well as opportunities for career growth and development.

Essential Functions:

1. Support updating and maintaining CHPW coding guidelines to reflect changes in external regulatory environment
2. Keep current on regulatory and coding issues/best practices
3. Present findings to internal and external audiences
4. Update and distribute provider feedback reports
5. Serve as coding operational lead and coding SME
6. Lead the risk adjustment coding and documentation quality assurance process
7. Identify and implement practices and QA process improvement opportunities
8. Monitor and comply with internal coding guidelines, department policies, and CMS risk adjustment guidelines
9. Support chart audit processes
10. Perform root cause analysis
11. Perform internal and external coding quality reviews

Qualifications:

1. Bachelor’s degree or an equivalent combination of education and highly relevant experience required
2. AHIMA CCS or AAPC CPC/H Coding Certification required
3. CRC required
4. Minimum five years combined experience performing diagnosis coding and conducting documentation and coding audits
5. Applied understanding of principles of reimbursement based on risk adjustment model(s)

Employment Eligibility:

1. Complete and successfully pass a criminal background check
2. Has not been sanctioned or excluded from participation in federal or state healthcare programs

Knowledge, Skills, and Abilities:

1. Knowledge of acceptable medical record standards and criteria
2. Strong written and verbal communication skills
3. Ability to multi-task and deal with complex assignments
4. Strong organizational and time management skills
5. Ability to design and update provider feedback report templates
6. Strong analytical skills
7. Proficiency and experience with EMR software and Microsoft Office products

Additional Information:

1. The position is FLSA Exempt (salary) and is not eligible for overtime.
2. The employer provides medical, dental, vision, and voluntary life insurance benefits, and 401(k) retirement benefits.
3. CHPW employees start earning 17 days of PTO and receive 40 hours of community service for volunteer time, and two floating holidays immediately.
4. The employer offers a monthly stipend to offset work-from-home expenses for roles that are 100% remote.
5. The contractor will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

About the company

Community Health Plan of Washington puts you at the center of your care, so when your needs change, we change too. That includes expanding our virtual care services, making personal phone calls to check on you, and providing home delivery of your presc...