Coding Specialist Risk Adjustment

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday-Friday

Job Location : Virtual

The role you'll contribute:

The Medicare Risk Adjustment Coding Specialist coordinates and supports retrospective and concurrent chart reviews in addition to education and chart retrieval for Health Plan audits and reports. Uses knowledge of Hierarchical Condition Categories (HCC) coding to translate, input, extract and validate medical record data.

The value you'll bring to the team:

• Review and assess documentation and accurately translates chronic conditions into the appropriate diagnosis code from inpatient and outpatient medical records
• Extracts data for Health Plan reports
• Inputs data collected from HCC programs
• Coordinates audits of Provider coding data
• Responsible for scheduling of audits
• Sends Provider the list for chart reviews and provides follow-up communication
• Assists in obtaining medical records from Providers to support audits requested by Health Plans
• Assists in coordinating Physician and staff training sessions

Qualifications
he expertise and experiences you'll need to succeed:

Minimum qualifications:

• Clinical experience per licensure/certification requirements listed below
• At least two (2) years of experience as a concurrent or retrospective documentation specialist depending on degree
• CDIP, CCDS or CPC (Clinical Documentation Improvement Practitioner/Certified Clinical Documentation Specialist/Certified Professional Coder) AND EITHER
• Three (3) years of experience as a concurrent or retrospective documentation specialist.

Preferred experience:

• Prior risk adjustment and medical record review experience
• Strong ambulatory background with a focus on diagnostic coding
• Experience with Medicare risk adjustment, Hierarchical Condition Categories (HCC), coding, billing, auditing and various healthcare payer

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