Risk Adjustment Coding Specialist I

Job Description Summary

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Formed in 2008 and headquartered in Fort Myers, Florida, with offices in Florida, North Carolina, and Texas, Millennium Physicians Group (MPG) is the largest independent physician group in the state of Florida and one of the largest in the United States. At Millennium Physician Group, our employees are the foundation of our success. Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual and help you grow in your role.

Under the direction of Burden of Illness department leadership, the Risk Adjustment Coding Specialist is responsible for various aspects of decision-making and coding reviews to facilitate, obtain, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect the severity of illness and complexity of patient care.

This position is responsible for risk adjustment coding and quality assurance validation for the following programs, including but not limited to:
• Prospective medical record review
• Concurrent outpatient claim diagnosis coding
• Retrospective medical record and provider response reviews

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How will you make an impact & Requirements

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Level I

• Perform prospective medical record reviews for clinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter.
• Review the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission to validate completeness and accuracy of provider selected ICD-10-CM codes.
• Collaborate with healthcare providers and other stakeholders to clarify documentation and ensure accurate coding and reporting of diagnoses.
• Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.
• Participate in coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.

• Stays current on applicable coding and documentation guideline changes and rules.
• This role is expected to maintain a consistent accuracy rate of 95% or higher and able to meet productivity standards established by leadership.
• Perform other job-related duties as assigned by leadership.