Risk Adjustment Coding Specialist II
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AI Summary
Abstract and assign ICD-10-CM diagnosis codes while conducting retrospective audits to ensure coding accuracy and completeness. Analyze Medicare Risk Adjustment data and monitor provider actions within the Value-Based Alert Tool to identify improvement opportunities.
Job Description Summary
ResponsibilitiesAbstract and assign ICD‑10‑CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher‑level coders.
Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
Perform comprehensive reviews of provider actions within the Value‑Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
Keep leadership aware of project activities through written and oral updates;
proactively identify project risks.
Consistently meet or exceed accuracy and productivity benchmarks.
May be assigned additional projects or a higher workload volume than a Level I specialist.
How will you make an impact & Requirements
RISK ADJUSTMENT CODING SPECIALIST
Qualifications
- Minimum 2 years of coding or related medical experience, including 1 year of HCC coding.
- Advanced knowledge of medical terminology, anatomy, physiology, and disease processes.
- Extensive understanding of ICD‑10‑CM conventions, documentation standards, and reimbursement systems.
- Strong technical skills, including proficiency with MS Office (Excel, Word, Access, PowerPoint).
- Demonstrated ability to use a variety of electronic medical record systems.
- Ability to manage a significant workload and meet deadlines with minimal supervision.
- Strong organizational, analytical, mathematical, and problem‑solving skills.
- Effective written and verbal communication abilities.
- Experience contributing to project work, educational development, or group presentations.
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