Job description

The Risk Adjustment Coder II provides support and coding expertise to all programs that support risk adjustment and data validation efforts for our Medicare, Commercial and PPO lines of business, along with other ad hoc and long-term projects assigned by the Manager, Government Programs. These projects impact revenue and prepare us for health plan, CMS and HHS audits. In addition, the Risk Adjustment Coder will provide analytics, education, in-person trainings in provider offices, and serve as the subject matter expert for all HCC coding initiatives, policies and procedures that adhere to our organizations coding guidelines and compliance standards. The position will interact with physician leadership, the provider network, and internal departments within the organization (e.g. Regional Services, Clinical Services, and Case Management). The ability to develop and maintain key relationships across the company will be critical.

Job Responsibilities

At the practice level:

• Identifies and implements Hill Physicians Annual Wellness Visit (AWV) resources that best meet practice needs (e.g. AWV appointment scheduling, weekend clinics, etc.).
• Coordinates AWV/Quality resources, monitors performance of interventions, and manages the process through completion.
• Prospective reviews of current conditions and suspect conditions.
• Stratify provider patients in order of priority for AWV scheduling.
• Provide lists of upcoming AWV visits to office staff, or AWV appointment scheduling vendor.
• Prepare AWV charts for provider’s upcoming AWVs to include HCC recapture and suspect Dx codes.
• Pull Open Care Gap reports, current lab and medication history.
• Work with practice staff to pull available specialist chart notes for HCC conditions that need to be recaptured.
• Concurrent review/real time education support and feedback during patient face-to-face visit to ensure coding and documentation accurately captures patient health status.
• Billing education/review to ensure all codes are captured on claim, including quality care gaps.
• Monitor and track practice performance in the areas of:
• HCC Recapture
• Suspect Capture
• RAF
• Quality – working with Pop Health for data

Chart Reviews

• Risk adjustment data validation to ensure accurate code submission.
• Develop HCC education materials for practices, panel meetings, new physician orientation, provider SMT and internal departments.
• Identify opportunities to improve documentation and coding accuracy, provide coding analysis and comprehensive summary of findings – Initiate HCC coding intervention with key practices to improve their coding accuracy.
• Analyze internal systems and platforms to identify and remedy issues that hinder complete encounter data capture.

Knowledge, Skills and Abilities

• Proficient in Microsoft Excel and Word
• Meeting facilitation
• Epic EMR experience preferred
• Proficient in Power Point
• Excellent organizational skills

Required Experience

• Professional medical coding credentials
• 2 years HCC coding and auditing (chart review) experience
• Proven history of project management and/or coordinating detailed projects or activities
• Ability to work independently and problem solve
• Ability to clearly communicate, both verbally and in written format
• Driver’s license and proof of auto insurance

Desired Experience

• Has worked in a doctor’s office

Required Education

• Bachelor’s degree preferred plus two years’ experience in a healthcare setting
• AAPC/AHIMA Certification

Additional Comments

• Travel to physician practices and regional offices will be required on a weekly basis. With few exceptions, travel will be limited to the San Francisco Bay Area, Sacramento, and San Joaquin and will occur within normal business hours with few exceptions.

Additional Information

Hill Physicians is an Equal Opportunity Employer

Work Remotely

• Temporarily due to COVID-19

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Supplemental pay types:

• Bonus pay

Experience:

• ICD-10: 3 years (Preferred)

Work Location: Hybrid remote in Sacramento, CA 95815

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