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Job Description:

Summary

The Risk Adjustment Coding Coordinator is responsible for various aspects of decision-making and implementation of medical coding reviews and coding policies to ensure accuracy and completeness in diagnosis coding. This position is responsible for risk adjustment coding and quality assurance validation for the following programs, including but not limited to prospective medical record review of health plan providers, retrospective medical record review of health plan providers, sole source and potentially unvalidated diagnosis (PUD) reviews, risk adjustment data validation (RADV) audits.

Essential Accountabilities:

Level I

+ Conducts chart reviews and audits utilizing knowledge and experience of ICD-10-CM coding, Medicare Advantage/Commercial Hierarchical Condition Categories (HCC), and Medicaid Clinical Risk Groups (CRGs) ensuring compliance with official ICD-10 guidelines, NYS law, and federal regulations.

+ Apply professional knowledge to ensure disease conditions are coded to the highest degree of specificity.

+ Performs vendor Quality Assurance (QA) and sole source PUD coding project reviews, including overread assignments.

+ Meets or exceeds established productivity metrics and 95% coding accuracy.

+ Regularly meets assigned internal project deadlines and all strict regulatory Risk Adjustment deadlines.

+ Maintain compliance with continuing education unit (CEU) standards. Staying current with professional development.

+ Ensure compliance with departmental and company policies & procedures and all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines for risk adjustment.

+ Extensive knowledge of coding conventions as they apply to medical record documentation, billing of medical services, and healthcare reimbursement systems. This includes a comprehensive understanding of ICD-10, and other types of coding submitted to the Health Plan by contracted facilities, and providers.

+ Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

+ Regular and reliable attendance is expected and required.

+ Performs other functions as assigned by management.

Level II (in addition to Level I Essential Accountabilities)

+ Conduct second level reviews as directed by leadership to ensure complete and accurate coding is captured across all projects prior to submission to state and federal regulatory bodies.

+ Participate in the Risk Adjustment Data Validation (RADV) audit, Initial Validation Audit (IVA), and Improper Payment Measure (IPM) audit.

+ Participate as needed in internal quality assurance reviews to assess coding accuracy on all coding coordinator staff.

+ Participate in strategic cross functional coding projects to enhance risk adjustment performance and compliance.

+ Mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.

+ Research best practices in risk adjustment coding and reviews the professional literature for coding updates, maintaining currency in coding. Evaluates, researches, and recommends enhancements to the risk adjustment program.

+ Proposes and develops new desk level procedures (DLP’s) and policies and procedures (P&P’s) as needed to support new and existing department initiatives, audits, and projects. Reviews and updates existing DLP’s, workflows, and P&P’s to ensure accuracy.

+ Establishes and maintains a repository for storing department documentation which may include corporate share drives, wiki, company intranet, and/or corporate website.

+ Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.

+ May assist or lead projects and/or higher work volume than Risk Adjustment Coding Coordinator I.

+ May support vendor discussions and feedback related to quality audit findings. Presents results and learning opportunities to the team.

Minimum Qualifications:

NOTE:

We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

+ One (1) year coding experience or directly related medical experience required.

+ Current Coding Certification (CPC, CPC-H, CPC-I, CCS) through AHIMA or AAPC required. In lieu of required certification and coding experience, CPC-A or CCA certification required.

+ High school diploma required.

+ Familiarity reviewing the components of a medical record.

+ Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.

+ Knowledge of medical coding methodologies, conventions and guidelines (e.g. ICD-9-CM, ICD-10, CPT, HCPC)

+ Familiarity and understanding of CMS HCC Risk Adjustment coding, Medicaid CRG coding, and data validation requirements, preferred.

+ Strong written and verbal communication skills; strong analytical, organization and time management skills required.

+ Proficient in Microsoft Office Suite (Excel, Word, Teams, etc.)

+ Adaptability to use new technologies to support medical record review (Encoder, EHR, NLP, Coding Platform)

+ Able to work independently and within time constraints.

+ Recognizes and properly handles confidential health information.

+ Able to efficiently prioritize multiple high-priority tasks.

+ Previous auditing experience desirable.

Level II (in addition to Level I Minimum Qualifications)

+ Three (3) years coding experience or directly related medical experience, one (1) of which includes Hierarchical Condition Categories (HCC) coding.

+ Extensive knowledge of coding conventions and payment rules as they apply to medical record documentation, billing of medical services, and health care reimbursement systems.

+ Comprehensive understanding and prior experience of ICD-10, and other types of coding submitted to the Health Plan by contracted facilities, and providers.

+ Demonstrated ability to utilize a variety of electronic medical records systems.

+ Ability to manage significant workload, and to work efficiently under pressure meeting established deadlines with minimal supervision. Strong time management skills. Must possess high degree of accuracy, efficiency and dependability.

+ Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization.

+ Strong analytical and mathematical skills.

+ Demonstrated experience in project completion, educational program development and/or group presentation.

+ Knowledge of healthcare industry.

Physical Requirements:

+ Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.

+ Ability to work in a home office for continuous periods of time for business continuity.

+ Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

+ Manual dexterity including fine finger motion required.

+ Repetitive motion required.

+ Reaching, crouching, stooping, kneeling required.

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One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we’re on a mission to make our communities healthier, and we can’t do it without you. We know inclusion of all people helps fuel our mission and that’s why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire for our employees’ interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I: Grade N8: Minimum $26.89 - Maximum $43.02

Level II: Grade N9: Minimum $29.57 - Maximum $47.32

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

With about 4,000 employees, 31 counties, and serving the needs of over 1.5 million members, you can imagine the gamut of skills it takes to keep our organization growing and our members flourishing. As an internal job seeker, this means growth and development in many directions, divisions, and roles.Take a look at information regarding our hiring process here. https://lifethc.sharepoint.com/sites/HumanCapitalManagement/SitePages/Talent-Acquisition-%26-Onboarding.aspx#hiring-process All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.