Value Based Coder II

DaMar Staffing; Houston (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

CommonSpirit Health is seeking a Value Based Coder II to review patient records for HCC opportunities and support risk adjustment initiatives.

The role emphasizes education delivery and process improvement within a risk adjustment framework, ensuring compliant coding across networks and providers.

Qualifications

• 2+ years of outpatient coding experience.
• 2+ years focused on risk adjustment and HCC principles.
• Advanced knowledge of CPT and ICD-10 coding with HCC guidelines.

Responsibilities

• Comprehensive record review to identify HCC opportunities and validate documentation.
• Develop and deliver education materials to improve HCC coding and provider education.
• Monitor CMS guidelines and ensure compliance in daily coding activities.
• Collaborate with providers to address documentation deficiencies and coding gaps.

Skills

CPT coding

ICD-10 coding

HCC coding

Risk adjustment

Education development

Tools

encoder software

records management software

medical information systems

Job description

Value Based Coder IIInspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 158 hospital-based locations, in addition to its home-based services and virtual care offerings.The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk-adjusting conditions and supporting provider documentation improvement.

1. Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and HCC. Validate the accuracy and completeness of HCC documentation and coding.
2. Advanced Documentation Improvement & Education: Analyze clinical documentation across the network to identify patterns, trends, and opportunities for improvement related to HCC capture. Develop and deliver effective education materials and tools to help network providers improve clinical documentation and support Hierarchical Condition Category coding capture. Provide targeted provider 1:1 education on documentation best practices, HCC guidelines, and risk adjustment principles.
3. Compliance & Regulatory Insight: Continuously monitor and interpret evolving HCC coding guidelines, CMS regulations, and compliance trends within the risk adjustment landscape, applying this knowledge to daily coding and education efforts. Champion a culture of compliance by advocating for best practices and providing robust provider support to ensure CommonSpirit adheres to all federal and coding guidelines pertaining to HCC and risk adjustment. Safeguard medical records and preserve the confidentiality of personal health information through adherence to all relevant policies (release of medical record information, record retention, HIPAA privacy and security).
4. Process Improvement & Collaboration: Actively participate in network performance improvement initiatives, offering insights and solutions based on coding expertise. Collaborate with providers and office staff to address documentation deficiencies and coding gaps.

Job Requirements

• 2+ years of experience in outpatient coding
• 2+ years focused on risk adjustment and HCC principles
• Advanced knowledge of CPT and ICD-10 coding, with significant expertise in HCC coding guidelines and risk adjustment models.
• Strong understanding of federal and state guidelines on all coding systems and sponsored programs.
• Proficiency in developing and delivering educational content.
• Effective interpersonal, communication, and presentation skills (both verbal and written).
• Ability to manage multiple priorities and work independently
• Computer literacy in medical information systems, records management software, and encoder software

Preferred/Desired Experience

• 4+ years of experience in outpatient coding
• 3+ years focused on risk adjustment and HCC principles