Value Based Coder II

The Value Based Coder II is an experienced professional within the Quality Management/Risk team responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, especially Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The coder supports clinically appropriate risk-adjusting conditions and provider documentation improvement.

Responsibilities include:

• Independent review of patient medical record information via population health tools to identify coding opportunities related to risk adjustment and HCC, validating accuracy and completeness of HCC documentation and coding.
• Analyzing clinical documentation to identify trends and improvement opportunities in HCC capture.
• Developing and delivering educational materials and providing 1:1 education on documentation best practices, HCC guidelines, and risk adjustment principles.
• Monitoring evolving HCC coding guidelines, CMS regulations, and compliance trends, advocating for compliance and best practices, and safeguarding medical records per HIPAA and related policies.
• Participating in network performance improvement initiatives and collaborating with providers to address documentation deficiencies.

Preferred experience includes 4+ years outpatient coding and 3+ years focused on risk adjustment and HCC principles.

Baylor St. Luke's Medical Center, located in Houston, TX, is a large academic medical center and part of CommonSpirit Health.