Risk Adjustment Coding Specialist

Job not on LinkedIn

🔥 47 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $23 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🏥 Medical Billing and Coding

🚫👨‍🎓 No degree required

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Baptist Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

Baptist Health is the region's largest not-for-profit healthcare organization in South Florida. It operates 12 hospitals, more than 29,000 employees, 4,500 physicians, and roughly 200 outpatient centers, urgent care facilities, and physician practices across Miami-Dade, Monroe, Broward, and Palm Beach counties. The system includes renowned centers of excellence in cancer, heart and vascular, brain and spine, and orthopedic care, and is supported by philanthropy and a faith-based mission. Baptist Health emphasizes clinical quality, patient safety, staff development, and community-oriented care.

📋 Description

• Performs medical record reviews prior to and following annual wellness visits and other identified visits to determine appropriate ICD-10-CM coding and billing and compliance with Medicare Risk Adjustment metrics • Support continuum of patient care by identifying patients with gaps in care or in need of MRA metrics reporting prior to each qualified visit • Document detailed chart audit findings including documentation errors, diagnosis errors as well as missed HCC opportunities in applicable audit tools on a daily basis • Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding • Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education • Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes • Facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness diagnoses • Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices

🎯 Requirements

• AAPC Certified Professional Coder • AAPC Certified Risk Adjustment Coder • Certified Professional Coder and/or Certified Risk Adjustment Coder (CRC) • CRC certification must be obtained within 1 year of hire • Required completion of an accredited certified coding specialist program • 2 + years of clinic or hospital experience and / or managed care experience • 1+ years of experience in Risk Adjustment and HEDIS/Stars • Ability to interpret, analyze and abstract data/documentation • Comprehensive knowledge of ICD-10-CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models • Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines • Intermediate level of proficiency in MS Office - Excel, PowerPoint, and Word • Ability to defend coding decisions to both internal and external audits • Strong organizational skills in multiple settings, as well as the ability to exercise judgment and initiative • Ability to work in a continuously changing environment

🏖️ Benefits

• Career growth and development opportunities, with clear pathways and ongoing support • Comprehensive health and wellness resources that go beyond traditional benefits • A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs • Tuition reimbursement to support continued learning and advancement