|Employer:||New England Quality Care Alliance
|Required Certifications:||or Equivalent,CPC,CRC
|Required Experience:||1 to 2 years
|Preferred Experience:||3 to 4 years
|Location:|| Braintree 02184, MA, US
I. GENERAL SUMMARY:
The Senior Risk Adjustment Coding Specialist works under the direct supervision of the Risk Adjustment Manager and collaboratively with others in the organization, including but not limited to Medical Directors, ACO Team members, Practice Performance Team Members, as well as network providers and their office staff. The Senior Risk Adjustment Coding Specialist’s primary responsibility is to ensure that our network providers maintain accurate and up-to-date adherence to ICD-10-CM/outpatient coding principles and guidelines, in order to support the network’s risk adjustment contracts and initiatives.
II. PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:
In close collaboration with the Risk Adjustment Manager, the Senior Risk Adjustment Coding Specialist will develop relationships with clinical providers/staff and the Risk Adjustment Coding Team in order to provide clear communication on accurate risk coding and clinical documentation requirements. A demonstrated knowledge of CMS Medicare Advantage, the ACA, value-based medicine, ACOs and other alternative payment models and their associated risk models is required. Project management of various risk coding initiatives and mentoring of other Risk Adjustment Coding Team members are essential functions of the position.
III. KEY RESPONSIBILITIES
- Understand, develop, track, monitor and report on key program performance metrics for coding initiatives, in collaboration with the Risk Adjustment Manager and other leadership.
- Conduct chart reviews for providers and review provider performance, and assist team members in similar initiatives.
- Create customized presentations to educate providers and staff, and conduct provider trainings on health plan coding initiatives guidelines and requirements of the Risk Adjustment Program to ensure correct coding and documentation.
- Ensure that ICD-10-CM diagnoses are reported in accordance with CMS payment and Risk Adjustment requirements, as well as with other risk contract guidelines.
- Work closely with internal representative for needs and support.
- Provide feedback and trending to leadership.
- Actively participate in internal / external meetings and training sessions.
- Participate in special projects and other activities associated with the Risk Adjustment Program as needed.
IV. JOB KNOWLEDGE AND SKILLS
- Presentation and training experience is necessary.
- Certified professional coder (CPC) and/or certified risk coder (CRC) or equivalent certification required.
- A proven ability to interact with all levels of management and to interact well with physicians must be demonstrated.
- Strong familiarity with Risk Adjustment methodology, advanced knowledge of ICD-10-CM coding and expert knowledge of medical terminology and abbreviations and disease, illness and injury processes required.
- 2-4 years of professional Risk Adjustment Coding experience required.
- Working knowledge of CMS Risk Adjustment model preferred.
- Expertise in Microsoft Office required, including Word, Excel and PowerPoint.
- Excellent written and verbal communication skills required.
- Strong organizational skills and ability to effectively prioritize and execute tasks in a high-pressure environment required.
- Experience with and enjoyment of working in a team-oriented, collaborative environment with a strong customer service orientation required.
- Valid Massachusetts driver’s license and own transportation for travel to network sites, as needed, is required
V. EDUCATION AND EXPERIENCE
- Bachelor’s Degree or higher preferred, as well as appropriate coding certifications (CPC and/or CRC or equivalent, as noted above).
VI. WORKING CONDITIONS/PHYSICAL DEMANDS:
- Work is in a fast-paced office-based setting.
- Reliable transportation is necessary. The NEQCA office is located in Braintree with travel to Local Care Organizations and community hospitals.
- Work often includes meetings outside of normal business hours
VII. AMERICANS WITH DISABILITIES STATEMENT
Must be able to perform all essential functions of this position with reasonable accommodation if disabled.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. New England Quality Care Alliance reserves the right to modify position duties at any time, to reflect process improvements and business necessity.