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Posted : Wednesday, May 08, 2024 07:16 AM
POSTED: December 27, 2023
POSITION: Risk Adjustment Compliance Coder
DEPARTMENT: Finance-Accounting
POSITION SUMMARY:
The Risk Adjustment Coder works to improve the quality of coding data which is imperative to support payments from Medicare and Medicaid.
Performs risk adjustment coding audits, conducts risk adjustment coding compliance research, answers risk adjustment coding questions, and serves as a subject matter expert in risk adjustment coding.
Supports the Medicare and Medicaid risk adjustment programs by assisting with development and implementation of risk adjustment program initiatives.
ESSENTIAL DUTIES AND RESPONSIBILITIES: 1.
Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
2.
Collaborates with Risk Adjustment Analyst to develop, implement, and continually refine prospective and retrospective diagnosis coding programs.
3.
Follows International Classification of Diseases (ICD)-10 guidelines for Coding and Reporting, Centers for Medicare & Medicaid Services (CMS) risk adjustment guidelines, understands the impact of ICD-10 coding on the CMS Hierarchical Condition Categories (HCC) risk adjustment model, and serves as the subject matter expert for risk adjustment activities.
4.
Assists with extraction of charts via remote Electronic Medical Record (EMR) access or faxed medical record request for risk adjustment initiatives.
5.
Performs comprehensive medical record review, verifying and ensuring accuracy, completeness, specificity, and appropriateness of diagnoses codes in accordance with ICD-10 guidelines based on medical record documentation.
6.
Maintains a comprehensive tracking and management tool to track all coding activities; generates and maintains accurate weekly, monthly, and quarterly reports of activities.
7.
Completes chart review encounter data submissions to CMS based on chart review findings.
8.
Provides support to the Risk Adjustment Analyst during the annual retrospective chart review performed by an external party.
9.
Identifies, develops, and delivers general and specific educational guidance to provider staff based on risk adjustment audit findings.
10.
Collaborates with internal departments, as appropriate, to carry out risk adjustment program activities to ensure integrity of diagnoses attributed to members submitted to the Michigan Department of Health and Human Services (MDHHS) and CMS by UPHP.
11.
Collaborates with a variety of external clients including health care management, physicians, and provider office personnel to streamline and optimize accurate diagnosis code capture.
12.
Maintains confidentiality of client data.
13.
Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS: Education: Minimum: High School Diploma Preferred: Associate degree in business, health information processing, or related field Certification: Minimum: Must possess and maintain an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification—Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC), or Certified Risk Adjustment Coder (CRC).
Preferred: Certified Coding Specialist (CCS-P, CCS, CPC) and Certified Risk Adjustment Coder (CRC) Experience: Minimum: Two (2) years of experience in a medical coding related position Preferred: Five (5) years of experience in a medical coding related position; working knowledge of managed care and health plan standards on Risk Adjustment Coding Other Qualifications: • Advanced knowledge and understanding of medical terminology, disease process, and anatomy and physiology • Advanced knowledge and understanding of CPT coding across a wide variety of provider specialties Required Skills: • Excellent organizational abilities with attention to detail • Ability to effectively communicate with, and educate, clinic staff (provider, care managers, clinic quality leads, etc.
) • Working knowledge of Microsoft Office (Word, Excel, Outlook) • Keyboarding proficiency • Research and analytical skills Preferred Skills: • Knowledge of MS PowerPoint • Oriented to managed care The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description.
The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements: [This job requires the ability to perform the essential functions contained in the description.
These include, but are not limited to, the following requirements.
Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]: Ability to access departmental files Ability to enter and access information from a computer Ability to access all areas of the UPHP offices Moderate physical effort (lift/carry up to 25 pounds) Occasionally lifts supplies/equipment Occasional reaching, stooping, bending, kneeling, crouching Prolonged periods of sitting Occasional prolonged standing Manual dexterity and mobility Working Conditions: Position available onsite (in Marquette, Michigan), fully remote, or hybrid with a remote work option up to three (3) days per week Works in office conditions, but occasional travel is required Exposure to situations requiring exceptional interpersonal skills or high productivity Occasionally subjected to irregular hours Subject to many interruptions Remote Work Requirements: Remote candidates must reside in the state of Michigan For fully remote team members, initial on-site/in-person onboarding and training for a minimum of ten (10) consecutive business days at UPHP’s headquarters in Marquette, Michigan (stipend provided) Periodic travel to UPHP’s headquarters for regular training including bi-monthly all staff meetings Private home office required; computer and phone hardware provided Personal vehicle required for periodic travel; mileage reimbursement provided at GSA rate
Performs risk adjustment coding audits, conducts risk adjustment coding compliance research, answers risk adjustment coding questions, and serves as a subject matter expert in risk adjustment coding.
Supports the Medicare and Medicaid risk adjustment programs by assisting with development and implementation of risk adjustment program initiatives.
ESSENTIAL DUTIES AND RESPONSIBILITIES: 1.
Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
2.
Collaborates with Risk Adjustment Analyst to develop, implement, and continually refine prospective and retrospective diagnosis coding programs.
3.
Follows International Classification of Diseases (ICD)-10 guidelines for Coding and Reporting, Centers for Medicare & Medicaid Services (CMS) risk adjustment guidelines, understands the impact of ICD-10 coding on the CMS Hierarchical Condition Categories (HCC) risk adjustment model, and serves as the subject matter expert for risk adjustment activities.
4.
Assists with extraction of charts via remote Electronic Medical Record (EMR) access or faxed medical record request for risk adjustment initiatives.
5.
Performs comprehensive medical record review, verifying and ensuring accuracy, completeness, specificity, and appropriateness of diagnoses codes in accordance with ICD-10 guidelines based on medical record documentation.
6.
Maintains a comprehensive tracking and management tool to track all coding activities; generates and maintains accurate weekly, monthly, and quarterly reports of activities.
7.
Completes chart review encounter data submissions to CMS based on chart review findings.
8.
Provides support to the Risk Adjustment Analyst during the annual retrospective chart review performed by an external party.
9.
Identifies, develops, and delivers general and specific educational guidance to provider staff based on risk adjustment audit findings.
10.
Collaborates with internal departments, as appropriate, to carry out risk adjustment program activities to ensure integrity of diagnoses attributed to members submitted to the Michigan Department of Health and Human Services (MDHHS) and CMS by UPHP.
11.
Collaborates with a variety of external clients including health care management, physicians, and provider office personnel to streamline and optimize accurate diagnosis code capture.
12.
Maintains confidentiality of client data.
13.
Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS: Education: Minimum: High School Diploma Preferred: Associate degree in business, health information processing, or related field Certification: Minimum: Must possess and maintain an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification—Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC), or Certified Risk Adjustment Coder (CRC).
Preferred: Certified Coding Specialist (CCS-P, CCS, CPC) and Certified Risk Adjustment Coder (CRC) Experience: Minimum: Two (2) years of experience in a medical coding related position Preferred: Five (5) years of experience in a medical coding related position; working knowledge of managed care and health plan standards on Risk Adjustment Coding Other Qualifications: • Advanced knowledge and understanding of medical terminology, disease process, and anatomy and physiology • Advanced knowledge and understanding of CPT coding across a wide variety of provider specialties Required Skills: • Excellent organizational abilities with attention to detail • Ability to effectively communicate with, and educate, clinic staff (provider, care managers, clinic quality leads, etc.
) • Working knowledge of Microsoft Office (Word, Excel, Outlook) • Keyboarding proficiency • Research and analytical skills Preferred Skills: • Knowledge of MS PowerPoint • Oriented to managed care The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description.
The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements: [This job requires the ability to perform the essential functions contained in the description.
These include, but are not limited to, the following requirements.
Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]: Ability to access departmental files Ability to enter and access information from a computer Ability to access all areas of the UPHP offices Moderate physical effort (lift/carry up to 25 pounds) Occasionally lifts supplies/equipment Occasional reaching, stooping, bending, kneeling, crouching Prolonged periods of sitting Occasional prolonged standing Manual dexterity and mobility Working Conditions: Position available onsite (in Marquette, Michigan), fully remote, or hybrid with a remote work option up to three (3) days per week Works in office conditions, but occasional travel is required Exposure to situations requiring exceptional interpersonal skills or high productivity Occasionally subjected to irregular hours Subject to many interruptions Remote Work Requirements: Remote candidates must reside in the state of Michigan For fully remote team members, initial on-site/in-person onboarding and training for a minimum of ten (10) consecutive business days at UPHP’s headquarters in Marquette, Michigan (stipend provided) Periodic travel to UPHP’s headquarters for regular training including bi-monthly all staff meetings Private home office required; computer and phone hardware provided Personal vehicle required for periodic travel; mileage reimbursement provided at GSA rate
• Phone : NA
• Location : Marquette, MI
• Post ID: 9034328013
