Lead, Risk Adjustment Coder

What You’ll Do 

Position Summary

The Lead, Risk Adjustment Coder plays an important role in achieving department objectives for the risk adjustment coding team.  This role will have split responsibilities, averaging 25% of time on administrative responsibilities, and 75% of time on daily coding responsibilities.  The Lead does not have direct supervisor responsibilities, but serves as the main point of contact to support the Coding team on a daily basis.  The Lead will serve as a resource for questions, basic coaching, and quality oversight for the front line Coding team, under supervision of the department Director.  The Lead will play a key role in being the primary subject matter expert for department operations, will assist in identifying best practices, and opportunities to improve quality, efficiency, and effectiveness of coding operations.  The Lead will continue to be responsible for coordinating/supporting prospective, retrospective, and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding to translate, input, extract and validate medical record data. The Lead Risk Adjustment Coder will serve as an important part of the care team to improve documentation and coding accuracy, and assist the primary care team to deliver high quality preventive care to patients.  Essential responsibilities consist of but not all inclusive:

Responsibilities

Lead Responsibilities:

• Training delivery for new hires, as well as update and refresher training for all team members
• Daily workload assignment in partnership with Director, Coding and Revenue Cycle Operations
• Proactively partner with leadership for subject matter expertise, and insights on opportunities to improve
• Perform quality assessments as assigned by supervisor, and communicate findings to supervisor and team members
• Monitor production and load balance to ensure productivity of all team members, and all work gets completed on time
• Serve as first point of contact for team members to answer questions
• Communicate changes and important updates to team members as shared by leadership
• Perform other duties and responsibilities as assigned

Coding Responsibilities:

• Review all available patient medical records: Medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, discharge summaries and any other available medical records. Determine whether the diagnosis codes are supported by the documentation and are within the guidelines for coding and reporting (M.E.A.T). 
• Conduct pre-visit and post visit audit process with assigned provider that accurately captures all documentation and coding with the greatest level of specificity. 
• Engage physicians and office staff to build and maintain a good working relationship. 
• Ensure frequent touchpoints with your assigned providers and schedule meetings to discuss chart review. 
• Assist in obtaining medical records from internal and external providers to ensure accurate documentation and to support audits requested by Health Plans. 
• Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment. 
• Educate physicians and supporting office staff on proper billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation. 
• Demonstrate the ability to quickly identify missing documentation and coding opportunities; incorrect coding and compliance trends; to analyze and investigate suspected problems with resolve; and to forward problems to the attention of your manager. 
• Coder is responsible for meeting daily production goal and quality goal of averaging 95% accuracy rate on a consistent basis. 
• Must have skill set for outpatient primary care coding and medical record reviews.  
• Suggest and educate providers on correct coding CPT/HCPCS Level II/ICD 10 CM/Modifiers 
• Must have knowledge on HEDIS Codes and NCQA guidelines. 
• Other duties as assigned. 

What You’ll Bring

Knowledge, Skills, and Abilities

• 2+ years in a Lead or Supervisory role (Preferred)
• ICD-10 coding: 3 + years (Required) 
• Medicare risk adjustment coding: 3 + years (Required) 

• Prospective and concurrent Risk adjustment retrospective review: 2 + years (Required) 
• Provider education – 1 + year experience (Required) 
• CPT and E&M coding: 1 + year (Required) 
• Outpatient Primary Care coding : 1+  year experience (Required) 
• Elation EMR (Preferred) 
• CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification (Required) 

Education, Experience, Licensure, or Certification Requirements

• High School or Associate’s Degree Required
• Clinical education (RN, LVN, LPN, Foreign Medical Graduate, Pharmacist) preferred

Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any type with regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.