Ambulatory Risk Adjustment Coding Specialist

Our Ambulatory Risk Adjustment Coding Specialist I plays a key role in identifying HCC codes within physician outpatient visits and ensuring they are coded accurately and to the highest specificity. They verify that documentation requirements are met to validate the HCC diagnosis code. The specialist works closely with the ambulatory clinical documentation specialist (CDS) to clinically verify the accuracy of HCC codes. Using compliant query guidelines, the coding specialist queries physicians if documentation requires clarification or specification. The role requires maintaining current knowledge of ICD-10-CM codes and guidelines and meeting minimum productivity requirements outlined by team leadership.

Responsibilities include reviewing and abstracting HCC codes for accuracy and documentation, identifying diagnosis and chart level impairments for provider education, partnering with clinical documentation specialists and physicians, recommending process improvements, assisting with onboarding new coding specialists, maintaining knowledge of coding and regulations, maintaining at least 95% accuracy on coding audits, and completing special projects as assigned.