Risk Adjustment Coder-Doc Spec - Samaritan Health Services

• JOB SUMMARY/PURPOSE
  • Develops, implements, and maintains auditing practices related to medical record coding and documentation to enhance risk adjustment outcomes for Medicare members. Ensures member medical records comply with CMS's Risk Adjustment Data Validation procedures. Responsible for ensuring risk score accuracy, identifying and communicating coding and documentation quality trends, and developing provider intervention strategies.
• DEPARTMENT DESCRIPTION
  • Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.
• EXPERIENCE/EDUCATION/QUALIFICATIONS
  • Bachelor’s Degree or equivalent experience required.
  • Current RHIA, RHIT or CPC Certified Coder through AAPC and/or AHIMA required.
  • Certified Risk Adjustment Coder (CRC) required within six (6) months of hire.
  • Two (2) years coding experience with at least one (1) year of specialized experience with the CMS-HCC (Hierarchical Condition Category) model required.
  • Experience with computer applications, including MS Office (Excel, Word, PowerPoint) required.
  • Experience with Epic workflows preferred.
  • Experience working in NLP coding platform preferred.
• KNOWLEDGE/SKILLS/ABILITIES
  • Excellent written and verbal communication skills to effectively communicate coding and documentation findings both internally and externally to providers and/or vendors.
  • Extensive knowledge of Medicare regulations and policies pertaining to documentation, coding, and billing.
  • Knowledge of clinical documentation requirements and its impacts to risk adjustment coding.
  • Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
  • Ability to self-motivate and work independently with minimal supervision.
  • Thorough understanding of ICD-10-CM coding guidelines and AHA coding clinics.
• PHYSICAL DEMANDS

  • Rarely
    (1 - 10% of the time)

    Occasionally
    (11 - 33% of the time)

    Frequently
    (34 - 66% of the time)

    Continually
    (67 – 100% of the time)

    CLIMB - STAIRS

    LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs

    LIFT (Knee to chest: 24"-54") 0 – 20 Lbs

    LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

    CARRY 1-handed, 0 - 20 pounds

    BEND FORWARD at waist

    KNEEL (on knees)

    STAND

    WALK – LEVEL SURFACE

    ROTATE TRUNK Standing

    REACH - Upward

    PUSH (0 - 20 pounds force)

    PULL (0 - 20 pounds force)

    SIT

    CARRY 2-handed, 0 - 20 pounds

    ROTATE TRUNK Sitting

    REACH - Forward

    MANUAL DEXTERITY Hands/wrists

    FINGER DEXTERITY

    PINCH Fingers

    GRASP Hand/Fist

PI251239933