As an integral member of the Covenant HealthCare Partners team, the Risk Adjustment Coding Specialist is responsible for ensuring providers document and code conditions in accordance with CHP standards. The role supports the HCC Coding Auditor Educator through provider education, chart review, and documentation improvement efforts that help increase revenue and improve risk adjustment performance.
This position reviews performance metrics, reports, and patient charts to identify opportunities for improved documentation practices, coding accuracy, and coding persistency. The specialist helps educate primary care, specialty care providers, and other clinical staff on improving specificity and completeness in HCC coding and documentation.
Key responsibilities include:
- Compiling payer data and Epic data related to risk coding and documentation performance
- Applying coding rules and guidelines to ensure quality coding based on the patient record
- Reviewing charts, interpreting documentation, and identifying opportunities for coding improvement
- Querying providers to address documentation and specificity opportunities
- Supporting pre- and post-encounter HCC review activities and physician meetings
- Assisting with HCC analytics, special projects, and presentation materials for leadership
- Participating in process improvement activities and development of coding support tools
- Ensuring compliance with CMS regulations, reimbursement policies, and accreditation guidelines
- Responding to compliance audit results and working collaboratively with department staff, physicians, and external customers
- Staying current on coding updates and maintaining professional credentials
Education and experience
- Associate degree required; bachelor's degree preferred
- Professional coding certification (CPC, CRC) required
- Two years of ICD-9/10-CM and CPT-4 coding experience may substitute for the CPC requirement, with CPC completion required within 12 months of hire
- Experience in a professional coding or physician office setting preferred
Knowledge and skills
- Familiarity with electronic health records, preferably Epic, Intelicode, Systoc, and AAPC-related tools
- Knowledge of medical terminology and anatomy
- Understanding of third-party payer coding and billing reimbursement
- Knowledge of ICD-9/10-CM diagnosis coding, CPT-4 coding, and HCPCS coding guidelines
- Demonstrated success with change management and quality improvement initiatives
- Strong relationship-building skills with physicians, nurses, and clinical staff
- Excellent communication, interpersonal, and problem-solving skills
- Proficiency in Microsoft Office
- Ability to travel to physician offices within the CHP network
- Ability to maintain confidentiality and comply with HIPAA standards
Benefits
- Comprehensive medical, dental, and vision coverage
- Retirement plans with employer match
- Paid time off to support work-life balance
- Employee wellness programs and mental health support
- Tuition reimbursement
- University discounts
- Professional development opportunities
Location
Michigan, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 weeks ago