Risk Adjustment Documentation and Coding Specialist (Telework)

Privia Health

Company Type

Overview of the Role:

We are currently recruiting for a Risk Adjustment Documentation and Coding Specialist to join our rapidly growing Revenue Cycle Management team. The successful candidate will have experience in documentation and coding validation and outpatient provider queries for Risk Adjustment purposes.

Primary Job Duties:

  • Validate ICD-10-CM code(s) and send a compliant documentation and coding query to providers when necessary
  • Identify coding gaps and missed coding opportunities for risk adjustment
  • Follow documentation and coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
  • Maintain compliance standards in accordance with Privia compliance policies
  • Evaluate the record for documentation consistency and adequacy
  • Ensure the final diagnosis code(s) accurately reflects the care and treatment rendered
  • Query providers as per Privia compliance policy and send follow up communications when necessary
  • Drop correctly coded claims and review for any coding holds
  • Perform other related duties, which may be inclusive, but not listed in the job description
  • Identify coding errors through claim holds
  • Meet team key performance indicators and quarterly objectives

Minimum Qualifications:

  • High School Diploma: Associates’ degree preferred
  • AAPC Certified Professional Coder (CPC) certification is required, CPC and Certified Risk Adjustment Coder (CRC) is preferred
  • Two years’ experience using ICD-9-CM/ICD-10-CM
  • EHR experience
  • Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance
  • Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes
  • MS Office Suite, Electronic Medical Records, Encoder, Coding Clinic, G-Suite, other software programs and internet based applications as needed to fulfill position duties
  • Health care insurance claims practice and compliance
  • Customer Relationship Management (CRM) preferred
  • Maintain patient, team member and employer confidentiality; comply with all HIPAA regulations

Interpersonal Skills & Attributes:

  • Excellent interpersonal skills
  • Establish and maintain effective working relationships with providers, management, clients and staff
  • Work in cooperation with corporate and clinic staff
  • Express ideas clearly and effectively
  • Respond calmly and maturely in high pressure situations
  • Use a customer-focused approach in dealing with conflict and resolution of problems
  • Excellent time management skills; Ability to work independently to accomplish assigned work in a timely manner
  • Clear and concise oral and written communication

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

It is an unlawful employment practice for an employer to fail or refuse to hire or discharge any individual, or otherwise to discriminate against any individual with respect to that individual’s terms and conditions of employment, because of such individual’s race, color, religion, sex, or national origin. 

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Confirmed 8 hours ago. Posted 30+ days ago.

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