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Risk Adjustment Specialist FT Days

Req #: 17009947
Location: Shawnee Mission, KS
Job Category: Risk Management
Organization: Shawnee Mission Medical Center

Full Time, Days
SMH has provided faith-based, whole person care to the Kansas City community since 1962. SMH is more than just a hospital campus. We’re a network of health care facilities working to exceed expectations by delivering quality care with compassion and supporting an exceptional staff of more than 700 physicians representing 50 medical specialties.
Our mission of Improving Health Through Christian Service is achieved every day through the dedication and commitment of our associates, physicians and volunteers. We strive to be a regional beacon of wellness, hope and healing attracting customers seeking unsurpassed clinical quality and compassionate care for the whole person, following the example of Christ's healing ministry.
As the largest health care provider in Johnson County, Kansas, the SMH network includes three campuses; Shawnee Mission Medical Center (SMMC) in Merriam, SMH - Prairie Star in Lenexa, and our newest campus: SMH - Overland Park at 159th and Antioch. Our 54-acre campus at SMMC is comprised of the main hospital, a community health education building, six physician office buildings and an associate child care center. The Emergency Department at SMMC is the busiest in Johnson County. We deliver more babies each year at the Shawnee Mission Birth Center than any other hospital in the metropolitan area and our Center for Women’s Health is nationally-recognized. We have eleven Shawnee Mission Primary Care locations with more than 30 Board-certified doctors who specialize in family medicine, internal medicine and pediatrics as well as four Centra Care Shawnee Mission Urgent Care locations.

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.


· 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



This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
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