Risk Adjustment Coding Specialist

The Risk Adjustment Coding Specialist will assess and ensure compliance with regulations for Family Care Network Practitioners and billing staff, reviewing medical records and coding information, and providing ongoing education and support. The role requires extensive experience with healthcare coding and billing processes, knowledge of Medicare managed care, and familiarity with EMR software.

Requirements

• Review medical record information to identify, collect, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC).
• Audit provider documentation of CPT and ICD-10 codes to ensure adherence with coding and CMS Risk Adjustment guidelines.
• Evaluate HCC audit processes and provide analysis and recommendations to improve overall provider documentation and coding.
• Responsible for ongoing provider education on HCC.
• Support and participate in process and quality improvement initiatives.
• Meet productivity and quality standards.
• Review Comprehensive Health Assessment forms.
• Performs other duties, as required.

Benefits

• Comprehensive benefits package
• Three Medical plan options
• Two Dental plans
• Employer-paid Vision coverage
• Expanded Employee Assistance Program (EAP)
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Health Reimbursement Account (HRA)
• Employer-paid Life/AD&D insurance
• Voluntary Accident and Hospital insurance plans
• Paid Time Off (PTO)
• Paid Sick Leave (PSL)
• Extended Illness Bank (EIB)
• 401(k) plan with employer match
• 401(k) Profit Sharing Plan
• Free financial planning guidance