Sr Risk Adjusted Coder

Company: Yakima Valley Farm Workers Clinic
Location: Zillah
Posted on: September 4, 2024

Job Description:

Join our team as a Sr Risk Adjusted Coder at the Toppenish Administration in Toppenish, WA, and be part of a healthcare organization that believes in making a difference beyond medical care! At Yakima Valley Farm Workers Clinic, we believe you are more than an employee, and we are more than a job! We value inclusivity, and we are a community committed to the well-being of our members.

We've transformed into a leading community health center. With 40+ clinics across Washington and Oregon, we offer a wide range of services such as medical, dental, pharmacy, orthodontia, nutritional counseling, autism screening, and behavioral health. Our holistic model also extends assistance to shelter, energy, weatherization, HIV and AIDS counseling, home visits, and mobile medical/dental clinics.

Explore our short clips, " WE are Yakima - WE are Family " and " YVFWC - And then we grew , " for a glimpse into our dedication to our communities, health, and families.

What We Offer

• $27.70 -$33.00/Hour DOE with ability to go higher for highly experienced candidates.
• 100% employer-paid health insurance for employees including Medical, Dental, Vision, Rx, 24/7 telemedicine; profit sharing, 403(b) retirement plan, generous paid time off, paid holidays, uniform allowance, and more.
  Essential Functions/Responsibilities/Duties
  
  • Support updating and maintaining CHPW coding guidelines to reflect changes of the ICD-10 CM Official Guidelines for Coding and Reporting, new AHA Coding Clinic Advice and new guidance from Center for Medicare & Medicaid Services (CMS). Interpret changes in the external regulatory environment and support modifying CHPW policies accordingly in coordination with the Risk Adjustment Supervisor and Risk Adjustment Program Manager. Keep current on regulatory and coding issues/best practices, including AHA Coding Clinics and ICD-10 Official Guidelines for Coding and Reporting.
  • Present findings via verbal and written updates to internal and external audiences, including peer-to-peer, department leadership (Manager, Director, Sr. Director, VPs) reporting, provider and clinical teams, and vendor support teams.
  • Update and distribute provider feedback reports periodically as needed for identifying provider performance trends and participate in creating templated materials to report all significant audit findings, including trends and associated recommendations (e.g., training, oversight, monitoring, process flow changes, documentation, and coding education) specific to internal departments, coding vendors, and others.
  • Serve as Risk Adjustment coding operational lead and coding SME. Coordinate with the Coding Supervisor to prioritize tasks of other full-time and/or temporary coding staff as needed. Support overread and validation of other coders' documentation review performance where appropriate.
  • Lead the risk adjustment coding and documentation quality assurance process and oversee the workflow of the retrospective coding review.
  • Identify and implement practices and QA process improvement opportunities.
  • Monitor and comply with internal coding guidelines, department policies, and CMS risk adjustment guidelines, rules, and regulations. Stay current with changes in the external regulatory environment and modify CHPW policies accordingly. Ensure timely review of regulatory and coding issues/best practices, including AHA Coding Clinics and ICD-10 Official Guidelines for Coding and Reporting.
  • Support chart audit processes, including audit provider and vendor documentation of ICD-9 and ICD-10 codes to ensure adherence with Center for Medicare Services (CMS) risk adjustment guidelines, and act as a liaison between internal departments and external entities on regulatory data validation audits (including CMS RADV and HHS RADV).
  • Perform root cause analysis to identify issues that may contribute to coding and documentation deficiencies.
  • Perform internal and external coding quality reviews to validate correct ICD-10-CM code assignments.
  • Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
  • Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer at its sole discretion.
    Qualifications
    
    • Education: Bachelor's degree Healthcare Information Management, Healthcare Administration, Business Administration or related field. Associate's degree with 2 additional years of coding and relevant revenue cycle experience. High School Diploma or GED with 4 additional years of coding and relevant revenue cycle experience.
    • Experience: Minimum three (3) years combined experience performing advanced diagnosis coding (ICD 9 & ICD 10, CPT, E/M, HCC, CDPS, etc.) AND conducting documentation and coding audits. Applied understanding of principles of reimbursement based on risk adjustment model(s) including CMS Hierarchical Condition Categories (HCCs) and HHS-HCC.
    • Preferred Experience:FQHC Billing Experience. Five years experience working in a healthcare setting with Epic software. Experience with Medicaid CDPS. Experience with NLP and computer-assisted coding applications.
    • Professional Licenses/Certificates/Registration: Any one of the certificates listed below is required:
      
      • American Health Information Management (AHIMA), or
        
      • Certified Coding Specialist (CCS), or
        
      • Registered Health Information Technician (RHIT), or
        
      • American Academy of Professional Coder (AAPC), or
        
      • Certified Professional Coder (CPC), or
        
      • Certified Professional Coder - Hospital (CPC-H) Coding, or
        
      • Certified Risk Adjusted Coder (CRC) OR Risk Adjustment Coding (RAC) if AHIMA-certified.
        
      • Certified Professional Medical Auditor (CPMA)
      • Knowledge/Skills/Abilities: Proficiency and experience with a variety of computer programs, including EpiCare, Prelude, Resolute PB, Word, and Excel. Applied understanding of principles of reimbursement based on risk adjustment model(s) including CMS Hierarchical Condition Categories (HCCs). Knowledge of acceptable medical record standards and criteria in the context of risk adjustment data validation (RADV) audit. Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers. Ability to multi-task and deal with complex assignments on a frequent basis; strong organizational, time management, and project management skills. Ability to design and update provider feedback report templates. Strong analytical skills and the ability to interpret, evaluate, and formulate action plans based upon data. Proficiency and experience with Microsoft Office products. Maintain consistent performance and attendance standards. Positive and constructive attitude with a team approach. Effective verbal, written and listening communication skills are essential.
        
        Our mission celebrates diversity. We are committed to equal-opportunity employment.
        
        Contact us at...@yvfwc.orgfor more information about this opportunity! Associated topics: actuarial analyst, actuary consultant, analyst, assistant actuary, investment actuary, mathmatics, model, probability, retirement actuary, statistics

Keywords: Yakima Valley Farm Workers Clinic, Yakima , Sr Risk Adjusted Coder, Accounting, Auditing , Zillah, Washington