full time healthcare

Job Details

Coding Coordinator, Risk Adjustment – Remote

  • Location: United States

The Bright Health Risk Adjustment and Coding Team is an integral component of Bright’s success as it defines and ensures outstanding clinical care for our members. As a Coding Coordinator, you will act as primary coding contact for compliance oversight with a focus on accuracy and potential coding opportunities. The coding coordinator will also be responsible for secondary-level quality audits.

YOUR RESPONSIBILITIES:

  • Participate in risk adjustment coding audits including but not limited to vendor bi-directional chart chases, gap closure, and coding completeness
  • Play a key role in medical records retrieval; including but not limited to calling provider offices, obtaining medical records from EMR systems, and partnering with market nurses for retrieval
  • Participate in secondary level quality audits of vendor’s work for RADV audits and other risk adjustment projects
  • Responsible for performing code abstraction... and/or coding quality audits of medical records to ensure that the ICD-10-CM codes are appropriately assigned and supported by clinical documentation
  • Identifies and tracks areas for documentation improvements and participates in documentation improvement initiatives
  • Maintain all coding certifications and requirements and keep up to date on knowledge of ICD-10 codes, CMS documentation requirements, and risk adjustment guidelines
  • Meet and maintain coding quality and productivity standards
  • Ensure compliance with all federal rules and regulations
  • Research and respond to coding questions submitted via the coding inbox

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

Required:

  • Associate degree or Bachelor’s degree required
  • Three (3) or more years of experience in Medicare Advantage and Commercial coding and risk adjustment
  • Current coding certification through AAPC or AHIMA
  • Extensive knowledge of risk adjustment and ICD-10-CM coding guidelines
  • Extensive knowledge of Medicare Advantage and Commercial HCC models
  • Proficient in Microsoft Office Products; Word, Excel, Powerpoint

Preferred:

  • Medical record retrieval experience
  • Certified Risk Adjustment Coder (CRC)
  • HHS IVA RADV experience

PROFESSIONAL COMPETENCIES:

  • Strong written and verbal communication skills
  • Strong attention to detail
  • Vast knowledge of EMR systems, medical record review, and abstraction
  • Ability to quickly learn and adapt to meet business needs
  • Experience working with Risk Adjustment vendors
  • Ability to work independently
  • Ability to build relationships with office staff, physicians, and market team

LICENSURES AND CERTIFICATIONS:

  • Current coding certification through AAPC or AHIMA
  • Certified Risk Adjustment Coder (CRC) preferred

ABOUT US

At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.

We’re Making Healthcare Right. Together

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