Risk Adjustment Coding Specialist II (Beaumont, TX)

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Base pay range

$70,000.00 / yr - $85,000.00 / yr

Department : Quality - Risk Adjustment

Location : 19500 HWY 249, Suite 570 Houston, TX 77070

Compensation : $70,000 - $85,000 / year

Description

We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry.

Responsibilities

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
• Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
• Perform code abstraction and / or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
• Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting / ambiguous or non-specific documentation
• Prepare and / or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
• Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, stay informed about changes in Medicare, Medicaid, and private payer requirements
• Provide recommendations to management related to process improvements, root-cause analysis, and / or barrier resolution applicable to Risk Adjustment initiatives
• Train, mentor and support new employees during the orientation process. Function as a resource to existing staff for projects and daily work
• Provide peer-to-peer guidance through informal discussion and overread assignments. Support coder training and orientation as requested by manager
• May assist or lead projects and / or higher work volume than Risk Adjustment Coding Specialist I

Qualifications

You're great for this role if

Environmental Job Requirements And Working Conditions

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information : The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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