Risk Adjustment Specialist FT Days
The Risk Adjustment Specialist is responsible for reviewing and abstracting the medical record using correct ICD codes and abiding by coding conventions to identify suspect conditions of high specificity.
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
· Review medical record information to identify all appropriate coding based on CMS HCC categories.
· Assigns and sequences ICD/CPT/HCPCS codes to diagnoses and procedures from documented information in the medical record.
· Assures the final diagnoses as stated by the physician and other healthcare provider are valid and complete and of the highest level of specificity.
· Reviews medical records to identify secondary complications and co-morbid conditions.
· Codes and abstracts all necessary information with most accurately describes each documented diagnoses and procedures.
· Provide support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards.
· Provide real time support and coordination with Primary Care Providers and Care Coordinators and other staff for MRA coding, HEDIS and STARS.
· Coordinate with clinical leadership in the development of provider training plans and for active support in the training process.
· Organize and schedule periodic training as indicated from chart review results, and/or as requested by Physicians Group leadership.
· Able to communicate precisely with medical staff and other healthcare providers.
· Monitor Coding changes to ensure that most current information is available.
· Meets coding productivity standards as outlined by department guidelines.
· Accept and thoroughly and skillfully complete special projects as assigned
· Adhere to policies, procedures, protocols and principles established by SPMG and other accreditation and/or regulatory bodies
· Attend and participate constructively in staff, practice manager, provider and all other meetings, both on and off site
· Provides conscientious commitment to assigned work, work schedule, honesty, teamwork, assisting others to bring about positive outcomes
· Verbally and behaviorally supports Shawnee Mission's mission and values
· 12+ months prior medical coding experience, strong knowledge of ICD-10 coding
· Strong organization and process management skills
· Strong collaboration and relationship building skills
· Excellent written verbal and written communication skills
· Proficient with Microsoft Word, PowerPoint and Excel
· Ability to drive to provider offices in the Kansas City area as needed
· Medicare Risk Adjustment HCC coding knowledge and/or experience
· 1 to 3 Years of Position-Related Experience
Preferred Licensure and Certification
· Strongly prefer Certified Risk Adjustment Coder (CRC)
· LPN or RN