Job Description

Job Description Summary

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The Risk Adjustment Coding Specialist II is responsible for reviewing a patient’s medical records after a visit and translating the information into provider-selected ICD-10-CM codes that insurers use to process claims from patients. Their duties include confirming treatments with medical staff, identifying missing information, and submitting forms to insurers for reimbursement ensuring the accuracy and completeness of provider selected ICD-10-CM codes before claim submission. You will also be required to abstract and assign ICD-10-CM diagnosis codes supported in the encounter documentation that were not initially assigned by the rendering provider. The specialist is responsible for various aspects of decision-making and coding reviews to facilitate, obtain, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect the severity of illness and complexity of patient care.

You will work in tandem with other members of the MRA Department and focus primarily on Concurrent outpatient claim diagnosis coding.

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How will you make an impact & Requirements

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Responsibilities

• Abstracts and/or validates the appropriate ICD-10-CM diagnosis code to the highest level of specificity supported in the patient record is present on the encounter claim before submission.
• Perform comprehensive reviews of provider actions within the VBAT to identify outliers and areas of opportunity.
• Keeps department leadership apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.
• Collaborate and work in tandem with other members of the MRA Department.
• Maintains active professional certification and complies with all educational, professional, and ethical requirements of said certification.
• Demonstrates knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions.
• Demonstrates ability to perform detailed oriented and complete encounter level reviews for Hierarchical Condition Categories (HCC)/Risk Adjustment.
• Possesses advanced knowledge and understanding of HCC/Risk Adjustment, coding, and documentation requirements.
• Ensures all diagnoses are accurate and complete from the patient encounter under ICD-10-CM Official Guidelines for Coding and Reporting.
• Demonstrates ability to identify and communicate trends in provider coding and documentation.
• Delivers clear, concise, and professional communications to providers as necessary when documentation is inadequate, ambiguous, or otherwise unclear for medical coding purposes.
• Responsible for documenting and tracking queries to providers in the identified database.
• Possesses excellent written, verbal, communication, and attention to detail skills.
• Review patient encounters to identify chronic and currently treated conditions, ensuring that official coding guidelines are followed.
• Demonstrate excellent guest service to internal team members and patients.
• Perform other related duties as assigned.

Qualifications

• High school Diploma or GED equivalent
• 2+ years of experience, in a payer or healthcare-related field.
• 3+ years of HCC Coding experience, preferred.
• Certified Procedural Coder (CPC), CRC designation preferred.
• Certified Documentation Expert Outpatient (CDEO), OR AAPC or AHIMA Approved coding credential, or equivalent.
• Must be proficient in 10-key, Word, and Excel.
• Maintains active professional certification and adheres to all industry educational, professional, regulations, and ethical requirements.
• Organizational skills with a focus on tracking patient care and improving patient flow.
• Proven knowledge of compliance and up-to-date guidelines regarding applicable coding and documentation.
• Understands and complies with policies and procedures for confidentiality of all patient records, HIPAA, and security of systems.
• Possesses excellent attention to detail.
• Ability to maintain a consistent accuracy rate of 95% or above.
• Works effectively and efficiently within a team environment.
• Must be able to meet productivity standards established by Leadership.
• Ability to work independently in a fast-paced, cross-functional environment.

Physical Demands

Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers. The worker must have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading. Ability to lift to 15 lbs. independently not to exceed 50 lbs. without help.

Equal Employment Opportunity

MPG is committed to equal employment opportunities. We will not discriminate against employees or applicants for employment in employment opportunities or practices based on race, color, sex (including pregnancy), genetic information, sexual orientation, religion, physical or mental disability, age, military or veteran status, marital status, familial status, national origin, or any other legally protected class.

Equal opportunity applies to all areas of the employment relationship, including hiring, promotions, training, terminations, working conditions, pay, and other terms and conditions of employment.

Millennium Physician Group (MPG) is committed to the full inclusion of all qualified individuals. In keeping with our commitment, MPG will take steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, contact HRbenefits@mpgus.com.

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Compensation Range:

$22.99

to

$34.49

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.