Risk Adjustment Coding Specialist-Excellus Fully Remote

POSITION PURPOSE:

The Risk Adjustment Coding Specialist works in a team environment and is responsible for reviewing clinical documentation and coding using HCC (Hierarchical Condition Category) and M.E.A.T (Monitored, Evaluated/Assessed/Addressed, Treated) standards while adhering to coding guidelines established by the Centers for Medicare and Medicaid Services (CMS).

Excellus contract specific RA Coding Specialist job primary functions:

• Working and managing a specific patient population of approx. 500 Excellus patients with the top 5 chronic conditions being required to be assessed and validated on an encounter, with notation of any invalid diagnoses.
• RA Coding Specialist will be the primary point of contact for Excellus contracted chronic condition validation.
• Review of the patient population chronic and/or suspect condition(s) gaps and provide these gaps via OPA in the EHR to the PCP prior to their next visit.
• HCC education and training will be conducted per Excellus payer risk adjustment coding guidelines and required of all PCPs within the practices of SJH. Education will include one-to-one chart reviews of an individual PCP’s charts with specific recommendations and education plan(s).
• Reporting on a weekly basis back to Excellus and SJH team of work completed and unable to complete as well as any educations provided.

Additional Department specific job functions:

• Participation in Quality Auditing of St. Josephs Health providers and department RA coders (2 currently requisitioned) with educational needs determination and communication to the Supervisor, RA Coding & Audit
• Key contributor duties related to CCD/HCC and other Risk Adjustment capture initiatives, as needed.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

• Certified Risk Adjustment Coder (CRC) required
• Excellent verbal and written communication skills.
• Customer service-oriented attitude/behavior.
• Detail-oriented with the ability to multi-task and complete tasks in a timely manner.
• Ability to work well as a team member.
• Intermediate computer skills: typing, 10-key, Word, Excel, Outlook and Teams.
• Adept in Electronic Health Records and Professional Billing systems
• High School Diploma or GED

ESSENTIAL FUNCTIONS:

Meets Health System's Guiding Behaviors and Caring Standards including interpersonal communication and professional conduct expectations with all coworkers, other departments, and with patients and visitors. Accurately codes (ICD-10-CM) to the most appropriate level of specificity. Follows current industry standards of ethical coding. Recognizes and reports opportunities for documentation improvement to the Supervisor of Risk Adjustment Coding & Audit to develop and implement provider documentation improvement plans. Ensures medical documentation and coding compliance with Federal, State and Private payer

regulations. Participates in continuing education activities to maintain their certification(s) and pertinent to areas of job responsibility. Performs additional duties as assigned. Adheres to St. Joseph’s Health’s confidentiality requirements as they relate to patient information.

What a Certified Risk Adjustment Coding Specialist will do:

• Review and assign accurate ICD-10-CM codes for diagnoses assigned in the EHR by the providers to claims being submitted for their services. Using billing system work queues as part of the pre-visit and post-encounter workflows, including queries to support addressing HCC codes for Risk Adjustment before a claim is submitted to payers.
• Demonstrate a solid understanding of ICD-10-CM coding and medical terminology, Hierarchical Condition Category (HCC), and M.E.A.T standards.
• Exercise a thorough understanding of ICD-10-CM coding guidelines, payer regulations, compliance and reimbursement, and the effects of coding in relation to risk adjustment payment models.
• Identify coding discrepancies and work with risk adjustment auditor/manager to communicate deficiencies to providers.

Core Values:

• Reverence: We honor the sacredness and dignity of every person.
• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.
• Justice: We foster the right relationships to promote the common good, including the sustainability of Earth.
• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.
• Integrity We are faithful to those we say we are.
• Safety: We embrace a culture that prevents harm and nurtures a healing, safe environment for all.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

• Must be able to set and organize own work priorities and adapt to them as they change frequently.
• Must be able to work concurrently on a variety of tasks/projects in physical or virtual environments

that may be stressful with individuals having diverse personalities and work styles.

• Must possess the ability to comply with Trinity Health policies and procedures.
• Must be able to spend majority of work time utilizing a computer, monitor, and keyboard.
• Must be able to perform some lifting and/or pushing/pulling up to 20 pounds if applicable.
• Must be able to work with interruptions and perform detailed tasks.
• If applicable, involves a wide array of physical activities, primarily walking, standing, balancing, sitting, squatting, and reading. Must be able to sit for long periods of time.
• 100% remote but if local may include some travel to sites.
• Must be able to travel to various Trinity Health sites (10%) as applicable.
• Telecommuting (working remotely), must be able to comply with Trinity Health’s and the Region/RHM Working Remote Policy.
• Please be aware for the safety and security of our colleagues and patients all new employees are required to undergo and pass all applicable state and federally-mandated pre-employment screening requirements including:
• Relevant Background Checks
• Drug Screen
• PPD / Tuberculosis Test
• Reference Check
• COVID Vaccination

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Note:

Bargaining unit employees are governed by the terms and conditions of their respective collective bargaining agreements, which supersede the Employment-At-Will Statement.

Pay Range: $25.60-$35.70 based on experience and location