Risk Adjustment Coding and Audit Specialist

Description

MISSION

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES

HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you’re starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE

The Risk Adjustment Coding and Audit Specialist is responsible for developing and maintaining medical record coding and auditing functions within the Risk Adjustment team.

Requirements

ESSENTIAL JOB DUTIES

Coding & Education Functions

• Provides quality oversight of the Medical Record Review process to ensure the accuracy of the codes being both submitted and retracted by both internal coding functions and by external coding vendors
• Uses information collected during audits to develop training and feedback initiatives for the HOA provider network 
• Works directly with provider offices on a regular basis to provide feedback and coaching support on Risk Adjustment and coding requirements
• Collects all required materials from internal HOA systems as well as provider offices to support Risk Adjustment programs
• Keeps informed of changes to the risk adjustment process and methodology and participates and/or directs research of special projects relevant to risk adjustment changes
• Acts as the internal Risk Adjustment subject matter expert and acts as a primary resource to the Quality Assurance, Medical Management, Pharmacy Services and Claims departments for relevant Risk Adjustment projects. 
• Provides clinical feedback on Risk Adjustment analytics, specifically the development of logic used to support the identification of medical records for review and members for in-home health risk assessments.

Audit Functions

• Develops and maintains an auditing dashboard to communicate the results of the audits and findings to internal and external stakeholders
• Develops audit processes and standard operating procedures that govern the Risk Adjustment team’s regulatory obligations around RADV audits, and submission of supplemental diagnosis codes
• Conducts overread audits on all coding projects conducted by internal and external sources.

General Requirements

• Maintains regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Works to encourage and promote Company culture throughout the organization
• Other duties as may be assigned

QUALIFICATIONS

• Associates degree or higher and at least two years coding experience in a managed care or primary care setting, or an equivalent combination of education
• Experience with Risk Adjustment models and methodology
• AHIMA certified credentials (RHIA, RHIT, CCS) or AAPC certified credentials (CPC, CPC-H, COC, CIC or CRC). Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) preferred.
• Demonstrated experience with ICD, CPT, DRG, and HCPCS coding systems
• Skilled in data collection, analysis, and data presentation methods
• Skilled with Microsoft Office Suite (Word, Excel, PowerPoint, Access)
• Excellent verbal, written, presentation and process/project management skills
• Problem resolution skills
• Ability to adjust to multiple demands & shifting priorities
• Self-directed; Able to work alone
• Possess a valid driver's license

PHYSICAL REQUIREMENTS

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS

401K (4% Match, Immediate Vesting) 

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