Risk Adjustment Coding Specialist

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

The Risk Adjustment Coding Specialist is responsible for comprehensive clinical documentation and coding chart review assigned for PacificSource Medicare Advantage Plans. This individual will collaborate with the Risk Adjustment Coding Manager to ensure the chart review process is maintained in accordance with coding expectations and meets the Medicare program regulations and coding guidelines set forth by the Centers for Medicare and Medicaid Services. This individual will be responsible to lead the application of a standardized HCC chart review process as a foundation of coding guidance supporting Medicare Advantage FFS lines of business, engage and develop strong relationships with all stakeholders at PacificSource Health Plans. This individual will also identify opportunities to improve provider documentation and deliver customized provider-specific documentation improvement recommendations to the Risk Adjustment Coding Manager for escalation purposes.

Essential Responsibilities :

• Provide support and coding expertise to all programs that support risk adjustment and data validation efforts for assigned PacificSource Health Plans, along with other ad hoc and long-term projects assigned by the Risk Adjustment Coding Manager.
• Assign appropriate ICD-10-CM codes, mapping to risk adjustment models as applicable.
• Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines.
• Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines.
• Assist in obtaining patient records from provider Electronic Health Record (EHR) systems.
• Assist in obtaining remote EHR access for our chart review vendors and internal PacificSource teams.

Supporting Responsibilities :

SUCCESS PROFILE

Work Experience : A minimum of 3 years of experience as a certified coder in professional setting. A minimum 2 years of risk adjustment HCC Coding experience. Ability to code using an ICD-10-CM code book. Computer proficiency (including MS Windows, MS Office, and High-speed Internet access.

Education, Certificates, Licenses : Active certified coder certification (CRC, CPC, CCS - P) through AHIMA or AAPC. Certified Professional Coder certification through AHIMA or AAPC. A CRC certification is required for this role.

Knowledge : Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation. Strong clinical knowledge related to chronic illness diagnosis, treatment, and management. Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred). Reliability and a commitment to meeting tight deadlines. Exemplary attention to detail and completeness. Strong organization, interpersonal, and customer service, written and oral communication, and analytical skills.

Competencies : Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment : Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills :

Accountability, Collaboration, Communication (written / verbal), Flexibility, Listening (active), Organizational skills / Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.