Risk Adjustment Coding Specialist

Risk Adjustment Coding Specialist: Central Valley Medical Providers in Fresno, CA

Position Summary: A great opportunity to work directly with a dynamic all-physician Board of Directors and talented management team to support the clinical needs of the fastest growing IPA in the Central Valley, serving Fresno and Madera Counties. Under the supervision of the Director of Operations, the Risk Adjustment Coding Specialist will be primarily responsible for partnering with providers and clinic operations staff to support CVMP’s Clinical Document Improvement (CDI) program and Risk Coding initiatives. 

Duties and Responsibilities

• Collect appropriate data from IPA network providers for HEDIS measures to close HEDIS & Star Measure gaps shared by health plans
• Advise and educate providers on CMS guidelines for Star Measures and appropriate documentation and coding for HEDIS reporting
• Collect and review medical records and ensure accuracy of documentation for reporting
• Collect, summarize, and trend provider performance data to include provider education
• Participate in ongoing discussions concerning data collections and analysis for HEDIS gap in care
• Assist in the planning and implementation of projects to improve the delivery of services and the quality of care
• Understand the principles of HIPAA and maintain the confidentiality of patient health information
• Understand the principles of CMS, HEDIS, NCQA, and more
• Communicate internally and externally as needed to gather necessary data
• Promote a positive working relationship with all stakeholders
• Attend IPA and health plan meetings as required
• Respond to primary care offices and health plan questions/inquiries promptly
• Support HEDIS/STAR member outreach campaigns.
• Perform other duties, projects, and actions as assigned

Qualifications and/or Experience:

• CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or AAPC Coding Certification (CCS-P, CPC, COC or CPC-P)
• At least 3 years of experience in a healthcare delivery organization, such as a managed care organization, medical group, or medical billing and coding
• Two years of experience in QI, performing a wide range of functions with a strong focus on data analysis and initiating improvement initiatives that achieve desired outcomes
• Computer literacy with knowledge and experience using specific software such as Word, Excel, and Access
• Knowledge of Commercial, Medicaid and Medicare programs required
• Must be willing to travel locally on an as-needed basis.

Primary Location: Fresno, CA, service area: Fresno and Madera Counties

Job Type: Full Time; In-office reporting position

Shift Type: Days

Compensation: $55,000-$61,000 a year