Senior Risk Adjustment Coding Specialist
PacificSource

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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: The Senior Risk Adjustment Coding Specialist will provider clinically based prospective and retrospective review of medical records to evaluate the quality of documentation for Risk Adjustment purposes; specific to the PacificSource Medicare Advantage Plans. This individual will collaborate with the Risk Adjustment Coding Manager to ensure the chart review process is maintained in accordance with coding expectations and meets the Medicare program regulations and coding guidelines set forth by the Centers for Medicare and Medicaid Services. This individual will be responsible to lead the application of a standardized HCC chart review process as a foundation of coding guidance supporting Medicare Advantage FFS lines of business, engage and develop strong relationships with all stakeholders at PacificSource Health Plans. The Senior Risk Adjustment Coding Specialist will work with assigned provider groups to ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. This individual will also identify opportunities to improve provider documentation and deliver customized provider-specific documentation improvement recommendations to the Risk Adjustment Coding Manager for escalation purposes and act as a liaison for those assigned provider groups.

Essential Responsibilities:

• Provides support and coding expertise and acts as a subject matter expert to all programs that support risk adjustment and data validation efforts for assigned PacificSource Health Plans, along with other ad hoc and long-term projects assigned by the Risk Adjustment Coding Manager
  
• Assign appropriate ICD-10-CM codes, mapping to risk adjustment models as applicable.
  
• Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines.
  
• Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirement.
  
• Comply with the Standards of Ethical Coding as set forth by the American Academy of Professional Coders and adhere to official coding guidelines.
  
• Assist in obtaining patient records from provider Electronic Health Record (EHR) systems.
  
• Assist in obtaining remote EHR access for our chart review vendors and internal PacificSource teams.
  
• Perform internal QA assessments on Risk Adjustment Coders on quarterly basis and provide education and training when necessary.
  

Supporting Responsibilities:

• Reliability and a commitment to meeting tight deadlines.
  
• Personal discipline to work remotely without direct supervision.
  
• Meet department and company performance and attendance expectations.
  
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  
• Complete other projects and duties as needed and assigned.
  

SUCCESS PROFILE

Work Experience: A minimum 3 years of risk adjustment HCC Coding experience with a minimum 5 years of experience as a certified coder in professional setting required. Ability to code using an ICD-10-CM code book. Computer proficiency (including MS Windows, and MS Office).

Education, Certificates, Licenses: Active certified coder certification (CRC, CPC, CCS - P) through AHIMA or AAPC Required. Certified Professional Coder certification through AHIMA or AAPC. A CRC certification is required for this role.

Knowledge: Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation. Strong clinical knowledge related to chronic illness diagnosis, treatment, and management. Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines (knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred). Reliability and a commitment to meeting tight deadlines. Exemplary attention to detail and completeness. Strong organization, interpersonal, and customer service, written and oral communication, and analytical skills.

Competencies

• Adaptability
  
• Building Customer Loyalty
  
• Building Strategic Work Relationships
  
• Building Trust
  
• Continuous Improvement
  
• Contributing to Team Success
  
• Planning and Organizing
  
• Work Standards
  

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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