Senior Coder, VBC Risk Adjustment

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.

SUMMARY

The Senior Coder, Risk Adjustment is responsible for expert review and execution of coding operational functions within USRC's Risk Adjustment department. This position will work closely with VBC Risk Adjustment leadership, USRC medical directorate, Compliance/Legal teams, and external coding vendors to ensure risk adjustment coding and documentation are compliant with organizational and federal guidelines.

 

Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.

• Working in tandem with the Manager, Value Based Care Risk Adjustment, this role will provide technical coding expertise and excellence in supporting risk adjustment coding operations.
• Maintain matrixed reporting environment between Project Manager(s), Legal, Compliance, IT, and internal VBC teams.
• Responsible for acting as USRC's subject matter expert regarding risk adjustment coding and documentation best practices.
• Serve as point of contact for external coding vendors and provide oversight to internal coding team member(s), including providing 2nd level review of coder output in USRC's internal systems. Maintain detailed records of coder and vendor performance and recommend corrective action plans for deficient vendors and/or specific coders.
• Independently coordinate with practice staff to gather and assess risk adjustment coding and documentation from various EMRs, ensuring encounters accurate and prompt coding of encounter.
• Develop and maintain documentation and workflows related to risk adjustment coding operations.
• Maintain current understanding of CMMI-HCC, CMS-HCC, and CMS-HCC-ESRD models, including Modified Hierarchies within the CMMI-HCC model that impact HCCs 135-138.
• Apply CKCC-specific risk adjustment methodology to concurrent coding practices, including detailed knowledge of the CMMI-HCC Concurrent Risk Adjustment Model and its relative factors, specifically post-kidney transplant indicators.
• Following ICD-10CM, Coding Clinic, and internal coding guidelines, complete coding and documentation for USRC aligned beneficiaries with a specific focus on kidney disease and its comorbidities.
• Complete chart reviews, audits, and inter-departmental work independently and in a timely manner.
• Actively promotes GUEST customer service standards; develops effective relationships at all levels of the organization.
• Participates in team concepts and promote a team effort; performs duties in accordance with company policies and procedures.
• Regular and reliable attendance is required for the job.

Qualifications

Qualifications/Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Requirements include:

• Associate degree or equivalent experience required; Bachelor's degree is a plus. Combination of education, specialty certifications and experience in related area will be considered in lieu of degree.

• Three (3) plus years of healthcare experience, specifically coding operations (audit, 2nd level review) in a risk-bearing provider organization and/or healthcare vendor.
• Prior experience managing workforce and or vendor relations
• Current CRC certification through AAPC required.
• Current CPC and/or CCS-P through AAPC/AHIMA required. Neither CPC-A nor CCS-P certifications will be accepted for this role.
• Desired certification(s): CPMA, CDEO, CDIP through AAPC/AHIMA
• Proficient with all Microsoft Office products, including Outlook, Vizio, PowerPoint and Word.
• Proficient with common EMR systems e.g., Allscripts, EPIC, AthenaHealth, PracticeFusion.
• Experience working with vendor risk adjustment solutions e.g., InovalonONE, Change, Cozeva, Pulse8, Apixio
• Advanced analytical skills required; Excel.