Job Description:
The Risk Adjustment Coding Lead 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, and 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 with the Director, 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 primary contact for external coding vendors, including providing 2nd level review of coder output in USRC’s internal systems.
- Maintain detailed records of vendor performance and recommend corrective action plans for deficient vendors and/or specific coders.
- Develop and maintain documentation and workflows related to risk adjustment coding operations
- Also be the mentor/guide for the 2 other coders (not directly managing)
- 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.
- Produce content that speaks to multiple levels of stakeholders, including executive summaries, management overviews, and front-line staff guides and workflows
- Complete chart reviews, audits, and inter-departmental work independently and in a timely manner (20 a day max)
OTHER:
- Interview times for this week
- 2 Rounds
- Start date in 2 weeks (URGENT)
Requirements:
- 7 years of experience Coding in Risk Adjustment
- Minimum of 3 years healthcare experience, specifically coding operations (audit, 2nd level review) in a risk-bearing provider organization such as Optum or other IPA Groups
- Active CPC and CRC Certification
- Bachelros Degree or Equivalent Experience
- Proficient with common EMR Systems and using multiple
- Eg. Allscripts, EPIC, AthenaHealth, Practice Infusion
- Proficient with all Microsoft Office products especially outlook, powepoint, and Excel
Nice to have:
- CPMA , CDEO, or CDIP Certification
- Nephrology Coding Experience/Knowledge