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(Includes all Level I responsibilities + the following)
Responsibilities
• Abstract and assign ICD 10 CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher level coders.
• Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.[HO1.1]
• Perform comprehensive reviews of provider actions within the Value Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
• Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
• Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
• Consistently meet or exceed accuracy and productivity benchmarks.
• May be assigned additional projects or a higher workload volume than a Level I specialist.
Risk Adjustment Coding Specialist II
Florida, USAPosted 4 days ago
FULL_TIMEonsite
Job Description
Job Description Summary
LEVEL II – RISK ADJUSTMENT CODING SPECIALIST (Intermediate)(Includes all Level I responsibilities + the following)
Responsibilities
• Abstract and assign ICD 10 CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher level coders.
• Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.[HO1.1]
• Perform comprehensive reviews of provider actions within the Value Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
• Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
• Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
• Consistently meet or exceed accuracy and productivity benchmarks.
• May be assigned additional projects or a higher workload volume than a Level I specialist.
How will you make an impact & Requirements
LEVEL II – RISK ADJUSTMENT CODING SPECIALIST (Intermediate)
(Includes all Level I responsibilities + the following)
Responsibilities
- Abstract and assign ICD‑10‑CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher‑level coders.
- Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
- Perform comprehensive reviews of provider actions within the Value‑Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
- Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
- Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
- Consistently meet or exceed accuracy and productivity benchmarks.
- May be assigned additional projects or a higher workload volume than a Level I specialist.
Qualifications
(In addition to Level I minimum qualifications)
- Minimum 2 years of coding or related medical experience, including 1 year of HCC coding.
- Advanced knowledge of medical terminology, anatomy, physiology, and disease processes.
- Extensive understanding of ICD‑10‑CM conventions, documentation standards, and reimbursement systems.
- Strong technical skills, including proficiency with MS Office (Excel, Word, Access, PowerPoint).
- Demonstrated ability to use a variety of electronic medical record systems.
- Ability to manage a significant workload and meet deadlines with minimal supervision.
- Strong organizational, analytical, mathematical, and problem‑solving skills.
- Effective written and verbal communication abilities.
- Experience contributing to project work, educational development, or group presentations.