At HealthPartners, you’ll find a culture where we live our values of excellence, compassion, integrity and most importantly, partnership. By working together, we will improve health and well-being, create exceptional experiences for those we serve and make care and coverage more affordable.
We currently have an exciting opportunity for a Risk Adjustment Coding Specialist. The Risk Adjustment Coding Specialist is accountable for increasing the partnership of the medical group and plan with focus on optimization in coding. This position is charged with facilitating and completing governmental/regulatory chart audits, reviewing suspect lists for accuracy as it relates to coding for medical group patients, and working strategically to create and enhance tools to ensure accuracy in coding as it impacts multiple areas for the Medical group and plan.
- Four year college degree or equivalent work experience.
- RHIA, RHIT, CPC, CCS, CCS-P credentials required.
- Minimum of two years experience in healthcare reimbursement or revenue cycle related position or five years of overall experience in healthcare.
- Must be able to obtain Certified Risk Adjustment Coder (CRC) credential within 6 months of hire.
- Demonstrated working knowledge of the revenue cycle process, compliance and federal/state regulations, CPT & ICD-10 Coding.
- Ability to identify issues and formulate solutions relating to revenue cycle process improvement initiatives.
- Ability to understand and communicate clinical documentation requirements for correct coding and to ensure integrity of the medical record.
- Extensive and solid knowledge of ICD-10-CM, CPT/HCPCS and clinical documentation standards.
- Demonstrated flexibility, organization and appropriate decision-making under challenging situations.
- Demonstrated skill and experience in effectively collaborating with team members & others using oral, written and interpersonal communications.
- Demonstrated PC skills in Microsoft Word, Excel, and/or Microsoft Access.
- Ability to organize and prioritize multiple assignments.
- Ability to deal with change and ambiguity.
- Able to work as a team member and also to act independently when needed.
- Experience working with Epic.
- Identifies revenue, reimbursement, and educational opportunities while remaining compliant with state and federal regulations.
- Identifies medical practitioner and Revenue Cycle Specialist educational opportunities relating to Epic clinical encounter documentation, the revenue cycle, and compliance.
- Performs reviews of member clinical encounter documentation for appropriateness and accuracy of physician claim submission retrospectively and prospectively.
- Performs risk adjustment data validation based on accurate diagnosis coding of HealthPartners health plan Medicare Advantage, Minnesota Senior Health Options (MSHO), Prepaid Medical Assistance Program (PMAP, under age 65), and MNCare products utilizing the HCC, HHS-HCC, CDPS, and ACG models.
- Performs risk adjustment data validation based on accurate diagnosis coding of identified HealthPartners health plan Commercial products and other ad hoc requests.
- Responsible for working with HPMG team members to identify clinical encounter documentation and reimbursement issues for resolution resulting in improved revenue flow and compliance issues.
- Ensures that rendered physician services for claim submission and subsequently payment are as accurate as possible while complying with regulatory guidelines including CMS, DHS, and OIG.
- Ensures all steps in the review process are clearly stated, documented, reported, and followed through to completion.
- Ensures that any process changes required for compliance are provided in a timely manner.
- Develops, maintains, and updates departmental review and reporting policies and procedures.
- Responsible to maintain confidentiality of information.
- Responsible for increasing organizational efficiency in daily operations.
- Responsible for communicating with other departments regarding process improvements, clinical documentation improvements and/or other educational opportunities.
- Responsible for performing training and educational seminars to Revenue Cycle Specialists, Physicians and Advanced Practice Providers on revenue cycle related topics.
- Responsible for increasing collaborative efforts between HealthPartners Health Plan and HealthPartners Medical Group as it relates to optimization of diagnosis coding, HCC/ACG impacts, revenue recovery, regulatory audits and associated revenue opportunities.
- Analyzes and organizes complex information for effective reporting to management and senior leaders.
- Remains knowledgeable on HPMG workflows and trained in Epic to ensure adherence to Medical Group Policies and Procedures.
- Responsible for other duties as assigned.
HealthPartners is recognized nationally for providing outstanding care and experience for patients and members. We offer an excellent salary and benefits package. For more information and to apply go to www.healthpartners.com/careers and search for Job ID #52301.
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