Risk Adjustment Coding Specialist I

Job Description Summary

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Formed in 2008 and headquartered in Fort Myers, Florida, with offices in Florida, North Carolina, and Texas,

Millennium Healthcare is the largest independent physician group in the state of Florida and one of the largest in the United States. At Millennium Physician Group, our employees are the foundation of our success. Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual and help you grow in your role.

The Risk Adjustment Coding Specialist I is responsible for reviewing the patient's medical record for clinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter. This role will leverage existing EHR tools and other technologies to identify suspect diagnoses impacting the patient’s health status. You will be required to prioritize and identify clinical indicators that are suggestive of an underlying condition. The Specialist is responsible for various aspects of decision-
making and coding reviews to facilitate, obtain, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect patient care needs.

This role focuses primarily on Prospective medical record reviews.

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How will you make an impact & Requirements

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Responsibilities
• Verify patient insurance coverage, eligibility, and benefits, before service
• Obtain prior authorization for all procedures, treatments, medications, and services, as required.
• Perform prospective medical record reviews for clinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter.
• Collaborate with healthcare providers and other stakeholders to clarify documentation and ensure accurate coding and reporting of diagnoses.
• Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.
• Participate in coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.
• Stays current on applicable coding and documentation guideline changes and rules.
• Demonstrates knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions.
• Maintain strict adherence to patient confidentiality according to provider standards and government regulations.
• Monitor and track the progress of referrals to ensure that patients receive the appropriate care promptly, providing regular updates to both patients and referring providers.
• Demonstrates ability to perform accurate and complete patient medical record reviews for Hierarchical Condition Categories (HCC)/Risk Adjustment conditions.
• Possesses advanced knowledge and understanding of HCC/Risk Adjustment, coding, and documentation requirements.

• Establish and maintain effective working relationships with physicians, staff, and management.
• Review patient medical records for clinical indicators.
• Coordinate referrals to other healthcare providers as necessary.
• Compile periodic reporting for various stakeholders.
• Demonstrate excellent guest service to internal team members and patients.
• Perform other related duties as assigned.

Qualifications
• High school Diploma or GED equivalent
• 1+ years of experience, in a payer or healthcare-related field.
• Must be proficient in 10-key, Word, and Excel.
• Certified Procedural Coder (CPC), CRC designation preferred.
• Certified Documentation Expert Outpatient (CDEO), OR AAPC or AHIMA Approved coding credential, or equivalent.
• Maintains active professional certification and adheres to all industry educational, professional, regulations, and ethical requirements.
• Organizational skills with a focus on tracking patient care and improving patient flow.
• Proven knowledge of compliance and up-to-date guidelines regarding applicable coding and documentation.
• Understands and complies with policies and procedures for confidentiality of all patient records, HIPAA, and security of systems.
• Possesses excellent attention to detail.
• Ability to maintain a consistent accuracy rate of 95% or above.
• Works effectively and efficiently within a team environment.
• Must be able to meet productivity standards established by Leadership.
• Ability to work independently in a fast-paced, cross-functional environment.

Physical Demands
• Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Repetitive motion. Substantial movements (motions) of the wrists, hands, and/or fingers. The worker must have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading. Ability to lift to 15 lbs. independently not to exceed 50 lbs. without help.

Equal Employment Opportunity
• MPG is committed to equal employment opportunities. We will not discriminate against employees or applicants for employment in employment opportunities or practices based on race, color, sex (including pregnancy), genetic information, sexual orientation, religion, physical or mental disability, age, military or veteran status, marital status, familial status, national origin, or any other legally protected class.
• Equal opportunity applies to all areas of the employment relationship, including hiring, promotions, training, terminations, working conditions, pay, and other terms and conditions of employment.

• Millennium Physician Group (MPG) is committed to the full inclusion of all qualified individuals. In keeping with our commitment, MPG will take steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, contact HRbenefits@mpgus.com.

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Compensation Range:

$20.90

to

$31.35

 

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.