Risk Adjustment Coding Specialist 2

**Job Description Summary** ‎  Under the direction of Burden of Illness department leadership, the Risk Adjustment Coding Specialist is responsible for various aspects of decision-making and coding reviews to facilitate, obtain, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect the severity of illness and complexity of patient care. ‎  **How will you make an impact & Requirements** ‎  **Responsibilities**   * Perform prospective medical record reviews for clinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter.  * Review the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission to validate completeness and accuracy of provider selected ICD-10-CM codes.  * Collaborate with healthcare providers and other stakeholders to clarify documentation and ensure accurate coding and reporting of diagnoses.  * Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.  * Participate in coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.  * Stays current on applicable coding and documentation guideline changes and rules.  * This role is expected to maintain a consistent accuracy rate of 95% or higher and able to meet productivity standards established by leadership.   * Abstract and assign ICD-10-CM diagnosis codes supported in the encounter documentation not initially assigned to the encounter claim following ICD-10-CM Official Guidelines for Coding and Reporting.  * Conduct retrospective audits of medical records to validate the accuracy and completeness of diagnosis coding and claim submission, identifying and resolving any discrepancies or areas for improvement.  * Perform comprehensive reviews of provider actions within the Value Based Alert Tool (VBAT) to identify outliers and areas of opportunity.   * Analyze MRA data to identify patterns and when requested assist in the development of interventions at the provider and region level.  * Keeps department leadership appraised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.  ‎  **Compensation:** $22.00 to $33.00