Risk Adjustment Coding & Documentation Specialist

Minimum 3 years of experience in risk adjustment coding and clinical documentation record review.

Certified Professional Coder (CPC) or Certified Coding Specialist-Physician Based (CCS-P) certification required.

Certified Risk Adjustment Coder (CRC) strongly preferred.

Proficient in various computer applications, including Microsoft Office, Excel, Word, PowerPoint, Visio, and Outlook.

Experience working in an electronic medical record; Epic strongly preferred.

Knowledge of ICD-10 coding guidelines, HCC/Risk Adjustment models, and documentation requirements for chronic condition capture and recapture.

Knowledge and understanding of official Evaluation and Management (E/M) guidelines and documentation requirements in support of proper E/M code assignment and establishment of medical necessity.

Demonstrates the ability to collaborate effectively with providers across all specialties on clinical documentation improvement initiatives and to communicate the importance of complete and accurate documentation to enhance diagnosis coding accuracy.

Self-motivated and able to work independently, demonstrating strong time management and prioritization skills to meet strict deadlines. Strong verbal and written skills.

Must possess ability to work independently with minimum direction and take initiative in problem solving.

Must be able to interact professionally and effectively with a wide variety of people, including operations staff, providers, the public, and departments in Valley Medical Center (VMC).

Requires typing, legible handwriting and computer/keyboard skills.

Regular and punctual attendance is a condition of employment.

Requires the ability to maintain self-composure and a positive attitude under stress.

Requires problem solving and coaching ability and effective resolution of conflicts.

Must be able to function effectively in an environment with frequent interruptions and multiple tasks.

Generic Job Functions: See Generic Job Description for Administrative Partner.

Essential Responsibilities and Competencies:

Ensure accurate and compliant provider documentation and HCC risk adjustment coding through pre- and post-visit reviews, gap identification, and collaboration with providers to support high-quality, value-based care.

Conduct detailed pre-visit chart reviews to identify active and suspected HCC conditions requiring assessment, documentation, and coding for upcoming patient encounters.

Develop and maintain standardized pre-visit review workflows to ensure consistent evaluation of chronic conditions, suspected conditions, and prior-year HCC's that need annual recapture.

Identify potential diagnosis opportunities and missing chronic conditions for providers in advance of visits using approved templates or tools in the electronic medical record.

Conduct post-visit documentation reviews to validate that all evaluated and treated conditions are accurately reflected and coded in the final visit note and claim.

Compare pre-visit opportunity to post-visit documentation to assess whether risk-adjusting diagnoses were addressed, documented with appropriate specificity, and coded during the provider encounter.

Collaborate with Risk Adjustment Auditor & Physician Educator to translate coding error trends and missed opportunities into targeted provider education topics.

Monitor and interpret risk-adjustment dashboards for diagnosis recapture and physician response rates communicating identified outliers and trends

Maintain current knowledge of the CMS Hierarchical Condition Category (HCC) payment methodology, documentation requirements, and CMS guidelines.

Perform new provider coding orientation related to Risk Adjustment diagnosis coding as needed or requested

Utilize available encoder and other coding resources to determine appropriate ICD-10-CM diagnosis codes mapped to HCC's.

Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, and staying current of industry coding, compliance, and HCC models.

Follow the Mission, Vision, and Values of Valley Medical Center. Perform all job functions in a manner consistent with Valley's cultural expectations defined as Valley Values. These characteristics include quality performance, demonstrating compassion, respect, teamwork, community-centered awareness, and innovation.

Complete additional projects and duties as assigned

Minimum 3 years of experience in risk adjustment coding and clinical documentation record review.

Certified Professional Coder (CPC) or Certified Coding Specialist-Physician Based (CCS-P) certification required.

Certified Risk Adjustment Coder (CRC) strongly preferred.

Proficient in various computer applications, including Microsoft Office, Excel, Word, PowerPoint, Visio, and Outlook.

Experience working in an electronic medical record; Epic strongly preferred.

Knowledge of ICD-10 coding guidelines, HCC/Risk Adjustment models, and documentation requirements for chronic condition capture and recapture.

Knowledge and understanding of official Evaluation and Management (E/M) guidelines and documentation requirements in support of proper E/M code assignment and establishment of medical necessity.

Demonstrates the ability to collaborate effectively with providers across all specialties on clinical documentation improvement initiatives and to communicate the importance of complete and accurate documentation to enhance diagnosis coding accuracy.

Self-motivated and able to work independently, demonstrating strong time management and prioritization skills to meet strict deadlines. Strong verbal and written skills.