Support Specialist, Risk Adjustment Coding

Your Future Evolves Here

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join Evolent for the mission. Stay for the culture.

What You’ll Be Doing:

The Risk Adjustment HCC Coding Support Specialist at Evolent will be an intricate part of the Risk Adjustment coding team. Coding for MSSP, MA and Commercial patients using the CMS HCC crosswalks, this coder will perform a comprehensive review of each progress note to ensure the clinical documentation in the supports the ICD-10 codes assigned to the claim to the highest level of documented specificity. Compliance with the ICD-10-CM Official Coding Guidelines and coding conventions as well as CMS Risk Adjustment Data Validation (RADV) documentation guidelines is applied daily.

Collaboration Opportunities:

This position serves as a technical point-of-contact for the mentioned functional areas and collaborates with leaders and providers as needed. This position may require communicating with the provider to obtain higher specificity for accuracy of code assignment. Clinical knowledge and high-level analytical skills are utilized in the review of each progress note to confirm clinical documentation support and appropriate ICD-10-CM code assignment for accuracy of risk score calculations.

What You Will Be Doing:

As a Risk Adjustment HCC Coding Support Specialist, you will perform a comprehensive review of progress notes to ensure that the clinical documentation supports the ICD-10 codes assigned to the claim to the highest level of specificity. Compliance with the ICD-10-CM Official Coding Guidelines and coding conventions as well as CMS Risk Adjustment Data Validation (RADV) documentation guidelines is applied to all reviews.

• The focus of this position is to confirm accuracy and specificity of ICD-10 diagnoses assigned on the claim are in accordance with the AHA ICD-10-CM coding guidelines, CMS clinical documentation guidelines and CMS RADV criteria.

• This position requires communicating with the coding team for accuracy and consistency as well as possible provider interactions to obtain higher specificity for accuracy of code assignment.

• Clinical knowledge and high-level analytical skills are utilized in the review of each progress note to confirm support of appropriate ICD-10-CM code assignment for accuracy of risk score calculations.

• This role is specific to provider clinical documentation and the requirements of CMS for RADV and reporting using the appropriate ICD-10 to HCC crosswalk supplied from CMS.

• Accurate coding with consistent demonstration of knowledge in the principals and practices of ICD-10-CM conventions applies continuously. You must enjoy reading and demonstrate the ability to put clinical pieces of documentation together for diagnosis coding specificity code validation and accuracy.

• Maintaining a high level of proficiency, productivity and accuracy with awareness and understanding of CMS RADV HCC compliance and guidelines will have you thriving in this position. Awareness, alertness, and the ability to understand the continuous changing guidelines and requirements for physician documentation and ICD-10-CM coding with excellent communication skills to mitigate risk to Evolent and its partners is a priority.

• Other projects and or deliverables as needed, this is not an exhaustive list of responsibilities.

Qualifications Required

• 2+ years in a Risk Adjustment HCC coding role as a Certified Risk Adjustment Coder (“CRC”) or equivalent. Experience in working with Primary Care Providers, Payers and/or Billing with college course work and working knowledge of anatomy, physiology, and pathophysiology to understand disease processes, treatment, or management of conditions is required. A bachelor’s degree preferred (Other college degree’s will be considered.) Certification as a RHIT /RHIA through AHIMA is acceptable.

• The preferred candidate will hold self-accountable to consistently meet daily productivity expectations while maintaining a pre-determin