Risk Adjustment Coding Specialist
Overview
TC2 is an Accountable Care Organization (ACO) participating in the Medicare Shared Savings Program and serving Medicare patients throughout Central/Middle Georgia. We are looking to add an experienced, self-motivated team member who will work in a collaborative effort directly with Providers and coding staff to identify opportunities to improve Risk Adjustment documentation and coding. The Medical Coder will conduct medical record audits, analysis of practice coding patterns and educate Providers and coding staff to ensure documentation and coding is performed to the highest specificity and that HCC scores are aligned with members’ burden of illness. The Medical Coder will generate reports reflecting audits findings and will coordinate with practice to provide HCC education.
Responsibilities
- Work as a member of the HCC Department and reports to the VP of CDI.
- Use approved educational materials to provide HCC training to TC2 Providers and support staff.
- Access Population Health tool to retrieve RAF scores and compile reports reflecting HCC gaps for practices.
- Abide by HIPAA and all other confidentiality agreements through TC2.
- Outreach to provider offices to facilitate virtual or on-site HCC training/education.
- Perform remote or on-site medical record audit to identify areas in need of improvement for HCC documentation and coding to increase HCC gap closure.
- Identify coding and billing discrepancies and discuss with practice.
- Keep track of outreach to provider offices.
- Keep track of feedback from provider offices and determine their level of engagement.
- Work with Practice Transformation Specialists to handle service requests from provider offices.
- Stay up-to-date on CMS regulatory and coding changes related to HCC model.
- Travel throughout designated territories on an as needed basis
Skills and Abilities:
- Excellent time management skills, organizational skills and people skills.
- Excellent written and verbal communication.
- Ability to work independently with minimal supervision.
- Ability to manage multiple assignments effectively and meet deadlines.
- Ability to keep a positive attitude and communicate with an array of personality types.
- Ability to conduct daily duties in a professional appearance and manner.
Minimum Qualifications:
High School diploma or GED.
Experience Required:
- 5+ years of experience in a hospital, a physician setting, or a Managed Care Organization as a Medical Coder.
- 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding).
- Experience in CPT coding.
- Other experience in teaching, training or an educator/instructor role required; but provider education experience is preferred.
- Other managed care experience.
Licenses and Certifications:
- Certified Professional Coder (CPC) required
- Certified Risk Adjustment Coder (CRC) preferred
Job Type: Full-time
Benefits:
Schedule:
Work setting:
Work Location: Hybrid remote in Macon, GA 31210