Risk Adjustment Coding and Outreach Specialist

Under the direction of the Supervisor, Risk Adjustment Coding, this position will be responsi

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ble for the ICD-10-CM diagnosis code capture for Affordable Care Act (ACA) and Medicare Risk Adjustment initiatives to include CMS required Medicare and Commercial Risk Adjustment and Risk Adjustment Data Validation (RADV) audits. The responsibilities of this position significantly impact the company’s risk adjustment revenue opportunities.

This position will retrieve, review, and analyze medical records for documentation to substantiate the medical diagnosis codes submitted on claims. Activities also include member and provider communication and education, scheduling, and process performance measurement to support closing both risk adjustment and quality care gaps. This position is in a fast-paced, developing area.

This position is eligible to work remote, hybrid or onsite by our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us

  • Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  • Family Comes First: Total rewards package that promotes the idea of family first for all employees.
  • Professional Growth Opportunities: Advance your career with ongoing training and development programs.
  • Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
  • Trust: Work for one of the most trusted companies in Kansas
  • Flexibility: options to work onsite, hybrid or remote available
  • Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

What you’ll do

  • Ensures compliance with all applicable Federal, laws and regulations related to coding and documentation guidelines for Commercial and Medicare Risk Adjustment Payment System.
  • Performs medical record review to capture of all relevant diagnosis codes included in the CMS and HHS Hierarchical Condition Categories (HCC) conditions for Commercial and Medicare Risk Adjustment Payment system.
  • Abstract diagnostic data and properly assign ICD-10-CM codes for both health Hierarchical Condition Categories (HCC) and Rx HCCs that map to a Risk Adjusted HCC ensuring the documentation meets all CMS standard requirements for valid HCC Submission.
  • Selects and accurately records all appropriate records and data on assigned chart abstraction projects.
  • Utilize medical coding software programs to abstract, analyze, and/or evaluate clinic documentation and enter diagnosis codes.
  • Comply with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, and compliance with Risk adjustment production standards.
  • Must meet 95% coding accuracy within 6 months and maintain accuracy in conjunction with department coding production guidelines.
  • Assist with requesting and processing medical records as needed.
  • Research and review provider submitted claims though Imaging resources.
  • Provide real time support and coordination with Providers for current audits.

What you need

  • High school diploma or equivalent
  • AAPC or AHIMA coding
  • One year of medical coding experience
  • Must be able to perform detailed research and data analysis.
  • Must have ICD-10-CM diagnosis and guidelines, medical terminology, anatomy, and physiology knowledge.

Bonus if you have

  • Risk adjustment HCC coding experience.
  • Medicare Advantage coding experience.

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