Coding Coordinator
Bright Health
YOUR RESPONSIBILITIES
- Participate in risk adjustment coding audits including but not limited to vendor bi-directional chart chases, gap closure, and coding completeness
- Play a key role in medical records retrieval; including but not limited to calling provider offices, obtaining medical records from EMR systems, and partnering with market nurses for retrieval
- Participate in secondary level quality audits of vendor’s work for RADV audits and other risk adjustment projects
- Responsible for performing code abstraction and/or coding quality audits of medical records to ensure that the ICD-10-CM codes are appropriately assigned and supported by clinical documentation
- Identifies and tracks areas for documentation improvements and participates in documentation improvement initiatives
- Maintain all coding certifications and requirements and keep up to date on knowledge of ICD-10 codes, CMS documentation requirements, and risk adjustment guidelines
- Meet and maintain coding quality and productivity standards
- Ensure compliance with all federal rules and regulations
- Research and respond to coding questions submitted via the coding inbox
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
Required:
- Associate degree or Bachelor’s degree required
- Three (3) or more years’ experience in Medicare Advantage and Commercial coding and risk adjustment
- Current coding certification through AAPC or AHIMA
- Extensive knowledge of risk adjustment and ICD-10-CM coding guidelines
- Extensive knowledge of Medicare Advantage and Commercial HCC models
- Proficient in Microsoft Office Products; Word, Excel, Powerpoint
Preferred:
- Medical record retrieval experience
- Certified Risk Adjustment Coder (CRC)
- HHS IVA RADV experience
PROFESSIONAL COMPETENCIES
- Strong written and verbal communication skills
- Strong attention to detail
- Vast knowledge of EMR systems, medical record review, and abstraction
- Ability to quickly learn and adapt to meet business needs
- Experience working with Risk Adjustment vendors
- Ability to work independently
- Ability to build relationships with office staff, physicians, and market team
LICENSURES AND CERTIFICATIONS
- Current coding certification through AAPC or AHIMA
- Certified Risk Adjustment Coder (CRC) preferred