Risk Adjustment Coding Specialist II (Northern Virginia)

Overview

Risk Adjustment Coding Specialist II (Northern Virginia) role at Astrana Health. This role will report to a Sr. Manager - Risk Adjustment and will conduct provider medical record audits, analysis of practice coding patterns, education and training regarding risk adjustment to ensure accurate CMS payment and improve quality of care.

Details

Department : Quality - Risk Adjustment

Location : Virginia, USA

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

What You'll Do

• 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

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.

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