Job Posting Title: Risk Adjustment and Coding Analyst
Location: Eagan, MN or Remote
· How Is This Role Important to Our Work?
This position is responsible for providing quality
assurance and coding audit services for risk adjustment purposes, supporting
ACA Commercial, Medicare and Medicaid programs. This includes the gathering,
analysis, interpretation and translation of medical and clinical diagnoses,
procedures, injuries, or illnesses into designated numerical codes, as well as
identifying opportunities for improvement and communicating those opportunities
to the appropriate internal teams.
A Day in the Life:
administrative duties related to the planning, scheduling, and conducting
coding audits and maintaining records associated with coding reviews and/or
audits of medical records for risk adjustment reporting.
records in accordance to current compliance policies to analyze provider
documentation to ensure that it meets standards and supports the diagnosis and
procedure codes selected, including supporting medical necessity severity of
illness and risk of mortality.
-Conduct audits on
abstracted files to ensure accuracy and completeness of coding by identifying
accurate coding opportunities and rechecking all diagnoses and procedures using
ICD-CM (ICD-9 and ICD-10) and CPT-4 codes to ensure adherence to all official
coding guidelines, federal and state regulations, health system and
departmental policies and productivity standards.
understanding of hierarchical condition categories (HCCs), and participates in
quality coding initiatives as appropriate or assigned.
preparation and implementation of necessary internal controls for related
entities consistent with CMS and State requirements to support RADV or other
knowledge of AHA Coding Clinic and ICD-CM (ICD-9 and ICD-10) Official
Guidelines for Coding and Reporting, and possess the ability to share this
knowledge with physicians and other patient care team members in a simplified
and concise manner.
communicating with physicians to provide feedback on medical record review
on proper clinical documentation, compliance, and coding guidelines.
and training to peers and providers, either in a one-on-one or group basis, on
correct and efficient coding and documentation practices.
Required Skills and Experiences:
1. Bachelors degree and 5 years of relevant
health plan or provider office medical coding/claims and/or Business Analyst
experience in a
applicable to claims/coding, or 9 years of relevant health plan or provider
office medical coding/claims and/or Business Analyst experience in a healthcare
setting applicable to claims/coding in lieu of a degree.
experience in auditing medical records.
Proficient knowledge of CMS-HCC model and guidelines.
Coding Certification required (CPC, CCS, CCS-P, or RHIT) in good
(Certified Risk Coder) in good standing, in addition to required coding
Attend continuing education classes to maintain coding proficiency and
adjustment methodology experience.
ability to apply critical thinking skills to coding policy interpretation and
Ability to travel
(locally and non-locally) as determined by business need.
Nice to Have:
of STAR, PAandR, IMS or other internal systems.