Risk Adjustment Coding Coordinator Job in Plano, Texas

Role and Responsibilities

The Coding Coordinator, under the direction of the Program Manager, is responsible for performing comprehensive medical chart reviews for the diagnosis code assignment and accuracy of HCC codes in various Managed Medicare products (e.g. Medicare Shared Savings Plan, Medicare Advantage) for an assigned Provider Network partnering with the Accountable Care Organization (ACO). This position is also responsible for identifying documentation deficiencies to be communicated back to the provider for improved accuracy in risk adjustment coding.

Core Functions

• Medical chart review to identify new risk adjustment codes using CMS-HCC methodology and ICD-10 CM coding guidelines
• Review potential risk adjustment codes for accuracy and provide evidence, recommendations, and documentation needed for codes
• Prep provider charts with code recommendations and quality gaps in care.
• Complete all provider chart reviews within designated timeframes
• Assist in the arrangement of Provider follow-up appointments and delivery of care
• Assist with data entry, faxing, filing and other clerical tasks

·       Support and participate in process and quality improvement initiatives

• Advanced understanding of Managed Medicare Clinical Quality measures, Risk Adjustment and overall framework of the Managed Medicare products
• Identify opportunities for improved processes and Provider Group participation in established ACO Managed Care programs.
• Continuous mindset toward efficiency and process improvement – how to apply technology and processes to improve delivery and efficiency from both the Provider Group and internal perspective
• Professionally represent the organization at all times; support the mission, goals and objectives; participate as a “team player”, constantly supporting other managers; set an example of high personal and professional conduct for employees and others
• Comply with all departmental policies and procedures
• Participate in departmental and company in-services as appropriate
• Perform other related duties as assigned

Qualifications and Education Requirements

• Medical Assistant, Licensed Vocational Nurse, or equivalent clinical work experience. High school graduate. Some college education preferred in the allied health professional field of study.
• Medical/clinical background highly desirable
• 1+ years of ICD10 coding experience
• Knowledge of CMS HCC Model and Guidelines along with ICD 10 Guidelines
• Preferred CRC or CPC certification
• Preferred 1-2 years’ experience in a physician’s office.
• Reliable transportation and the ability to travel between ACO member offices
• Excellent written/verbal communication skills, especially the ability to communicate telephonically in a professional and effective manner
• Confident working with heath care professionals
• Passionate about your work and move forward with purpose; demonstrate clear value and support of your Provider Groups and internal teams
• Approach problem solving that involves systems thinking – understanding how the process works and how people are impacted by your decisions
• Strong communication skills – understanding the need for being inclusive for effective results; communicate effectively with both day to day operational resources and executive management.
• Understand sense of urgency and fast-paced; strong organizational skills
• Solutions oriented, willing to bring Provider Groups results regardless of roles or titles
• Experience with basic Microsoft Office Applications
• Experience in EHR preferred