Senior Risk Adjustment Coding Specialist

Summary

Join Homeward, a company dedicated to improving healthcare access in rural America, as a Senior Risk Adjustment Coding Specialist. This hybrid role, requiring some on-site presence in Minneapolis, Austin, Chicago, or the San Francisco Bay Area, focuses on ensuring the accuracy and compliance of Medicare & Medicaid risk adjustment coding processes. You will educate clinicians and support staff on proper coding and documentation practices, directly impacting the quality of care and appropriate reimbursement. This role involves auditing medical records, collaborating with clinicians to improve documentation, staying updated on CMS guidelines, promoting accurate coding practices, ensuring compliance with regulations, and integrating risk adjustment best practices into healthcare processes.

Requirements

• 5 years of experience in medical coding, healthcare education, or a related field, with a strong focus on Medicare risk adjustment
• Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) certification
• In-depth knowledge of Medicare & Medicaid risk adjustment methodology and coding guidelines
• Strong understanding of ICD-10-CM diagnosis coding
• Excellent communication skills
• Familiarity with electronic health record (EHR) systems
• Knowledge of healthcare compliance, regulations, and billing practices
• Analytical and problem-solving skills

Responsibilities

• Auditing and Feedback: Conduct regular audits of medical records, coding, and documentation to identify areas of improvement. Provide feedback and coaching to clinicians to address deficiencies
• Documentation Improvement: Collaborate with clinicians and support staff to identify opportunities for improving documentation to support accurate coding, risk adjustment, and compliance
• Coding Guidelines: Stay updated with the latest CMS (Centers for Medicare and Medicaid Services) risk adjustment guidelines and regulations to ensure education materials and training programs are current
• Coding Accuracy: Promote and maintain accurate and complete coding practices that reflect the severity and complexity of patients' conditions to optimize risk adjustment factors
• Compliance: Ensure adherence to all regulatory requirements, including Medicare, Medicaid, and CMS guidelines, and provide guidance on avoiding fraud, waste, and abuse in coding and documentation
• Quality Improvement: Collaborate with quality improvement teams to integrate risk adjustment coding best practices into healthcare processes and improve the overall quality of care
• Communication: Communicate changes in risk adjustment coding policies and guidelines to staff, as well as assist in resolving coding-related issues

Preferred Qualifications

• Additional AAPC or AHIMA certification (RHIA, RHIT, CDIP etc.)
• Approved instructor certification through AAPC or AHIMA
• Experience with risk adjustment technology solutions and risk adjustment vendors
• Previous experience building from the ground up on a small, fast-paced team

Benefits

• Competitive salary and equity grant
• Unlimited Paid Time Off
• Comprehensive benefits package including medical, dental & vision insurance with 100% of monthly premium covered for employees
• Company-sponsored 401k plan
• Flexible working arrangement