Department: Quality - Risk Adjustment
Location: Monterey Park, CA, with travel to provider offices in San Francisco, San Mateo, and Santa Clara.
Compensation: $70,000 - $85,000 per year.
We are seeking a highly motivated Risk Adjustment Coding Specialist to support the Northern California market. In this role, you will conduct high-volume chart reviews to identify coding gaps, trends, and opportunities to improve accuracy for providers. You will translate findings into actionable insights, create and deliver education to providers and practice leaders, and track performance metrics such as HCC recapture rates, AWVs, and other KPIs to support provider performance and program success.
This role follows a hybrid work structure with weekly field and home work. There can be weeks that are fully remote, and other weeks with increased in-office provider needs. Travel to provider offices may be required up to 50% of the time, with a stated maximum of 75% of work time in the qualifications.
Responsibilities
- Review provider documentation of diagnostic data from medical records to verify risk adjustment documentation requirements for Medicare Advantage, ACO, and Commercial plans.
- Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information related to HCC.
- Perform code abstraction and coding quality audits to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
- Interact with physicians regarding coding, billing, documentation policies, procedures, and ambiguous or non-specific documentation.
- Prepare auditing analysis and provide feedback on noncompliance issues detected through audits.
- Maintain current knowledge of coding regulations, compliance guidelines, and ICD-10 and HCC updates.
- Provide recommendations to management related to process improvements, root-cause analysis, and barrier resolution.
- Train, mentor, and support new employees during orientation and serve as a resource to existing staff.
- Provide peer guidance through informal discussion and overread assignments.
- Assist with projects and higher work volume as needed.
Qualifications
- Active AAPC or AHIMA certification required: CCS-P, CCS, or CPC.
- At least 3 years of risk adjustment coding and/or billing experience.
- Reliable transportation and valid driver's license.
- Ability to travel up to 75% of work time.
- Proficiency with Microsoft Word, Excel, and Outlook.
- Strong verbal, written, and presentation skills.
- Ability to educate and train provider office staff.
- Experience with healthcare coding software and electronic health records (EHR) systems.
- Preferred: CPB certification, CRC certification, risk adjustment coding experience, PowerPoint and public speaking experience, Monday.com experience, and face-to-face provider education experience.
Location
San Francisco, California, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$70,000 - $85,000
Remote work allowed
Yes
Posted
1 month ago