Risk Adjustment Coding Specialist

Full Time
$20.73 - $25.08 an hour
Posted 10 days ago
Job description

Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 24,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World’s Most Ethical Companies.

Everything we do at Baptist Health, we do to the best of our ability. That includes supporting our team with extensive training programs, millions of dollars in tuition assistance, comprehensive benefits and more. Working within our award-winning culture means getting the respect and support you need to do your best work ever. Find out why we’re all in for helping you be your best.


Performs medical record reviews prior to and following annual wellness visits and other identified visits to determine appropriate ICD-10-CM coding and billing and compliance with Medicare Risk Adjustment metrics. Support continuum of patient care by identifying patients with gaps in care or in need of MRA metrics reporting prior to each qualified visit. Document detailed chart audit findings including documentation errors, diagnosis errors as well as missed HCC opportunities in applicable audit tools on a daily basis. Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding. Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education. Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes. Facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness diagnoses. Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices. Estimated pay range for this position is $20.73 - $25.08 / hour depending on experience.


Degrees: High School,Cert,GED,Trn,Exper Licenses & Certifications: AAPC Certified Professional Coder AAPC Certified Risk Adjustment Coder Additional Qualifications: Certified Professional Coder and/or Certified Risk Adjustment Coder (CRC). CRC certification must be obtained within 1 year of hire. Required completion of an accredited certified coding specialist program.2 + years of clinic or hospital experience and / or managed care experience. 1+ years of experience in Risk Adjustment and HEDIS/Stars. Ability to interpret, analyze and abstract data/documentation. Comprehensive knowledge of ICD-10-CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models. Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines. Intermediate level of proficiency in MS Office - Excel, PowerPoint, and Word. Ability to defend coding decisions to both internal and external audits. Strong organizational skills in multiple settings, as well as the ability to exercise judgment and initiative. Ability to work in a continuously changing environment.


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