Physician Risk Adjustment Coding Specialist

  • Location FRANKLIN, TN (CHS Corporate)
    Full Time
  • Department Physician Coding & Doc
  • Field Health Information Mgmt
  • Location FRANKLIN, TN (CHS Corporate)

  • Department Physician Coding & Doc

  • Field Health Information Mgmt

  • Full Time

Job Description

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 44 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 78 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

To code and abstract all inpatient, outpatient and emergency service diagnoses, procedures and conditions as indicated in the medical health record pertaining to the CMS-HCC model and risk adjustment.

Essential Duties and Responsibilities:

  1. Identify, collect, assess, report, monitor and document claims and encounter coding information as it pertains to Hierarchical Condition Category (HCC) codes and Risk Adjustment.
  2. Verify and ensure the accuracy, completeness, specificity and appropriateness of ICD-10-CM codes based on services rendered.
  3. Review medical record information to identify all appropriate coding based on the CMS HCC model.
  4. Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
  5. Provide education and training related to quality of documentation, level of service and ICD-10-CM coding consistent with established coding guidelines and standards to physicians, non-physician practitioners, and any applicable support staff.
  6. Monitor Coding changes to ensure that the most current information is available.
  7. Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
  8. Create and submit compliant physician queries as needed to clarify missing or inadequate medical record information required to complete the coding assessment and adhere to documentation and billing requirements.
  9. Makes corrections as needed to ensure accurate coding and billing and reimbursement processing.
  10. Maintains a working knowledge of CPT, HCPCS and ICD-10-CM coding principles, governmental regulations, protocols and third party requirements regarding billing and documentation.
  11. Remains current on all changes in legislative regulations that impact HCC/Risk Adjustment coding.
  12. Ensures assigned projects are completed in a timely manner
  13. Maintains strict confidentiality of provider information, patient data, financial and billing information
  14. Reports noncompliance issues detected through the coding and billing process to supervising Manager, Director and/or Sr. Director Physician Coding and Documentation
  15. Complies with all policies and procedures of the Corporate Compliance Program
  16. Attends meetings as requested, which may necessitate working in the evening or very early morning
  17. Assists with special projects as assigned by supervising Manager, Director, and/or Senior Director of Physician Coding and Documentation
  18. Work with other staff members to inspire teamwork and promote cooperation
  19. Will perform non-HCC coding duties when needed

Required Education: GED or High School Diploma

Required Experience:

  • Minimum of 5 years experience working with physician offices or clinics working with diagnostic and procedure coding and/or medical billing.
  • Fluent in the English language
  • Minimum of a GED or High School Diploma
  • 2+ years of working as a medical coder (where coding was 90% or more of job duties, and were held to quality and productivity goals).
  • Minimum of 3 months experience performing HCC/Risk Adjustment coding
  • Possess knowledge on the CMS HCC model of Hierarchical Condition Category (HCC) coding.
  • Through knowledge of AHIMA’s compliant physician queries guidelines and standards.
  • Possess a vast knowledge of CPT, ICD-10-CM and HCPCS coding and reimbursement issues for physician offices and clinics
  • Strong knowledge of AMA and CMS Documentation guidelines
  • Excellent understanding and comprehension of medical, anatomy and physiology terminology. (Pathophysiology knowledge helpful).
  • Must have the ability to balance and juggle multiple tasks, projects and requests
  • Must be able to make sound decisions objectively and follow through
  • Ability to communicate effectively any issues or weaknesses with coding and documentation to the providers
  • Must be detail oriented and analytical
  • Able to interact confidently with providers, staff, corporate CHS management and/or other CHS affiliated personnel
  • Normal visual and auditory activity is required
  • Emotional and mental stability required to deal with periods of high stress
  • Possess clinical knowledge and ability to evaluate and summarize clinical records to support successful appeal

Preferred Experience: 1+ years of experience performing HCC/Risk Adjustment coding.

Required License/Registration/Certification: CPC, CCS-P, CBCS, CRC, CCDS, or CDIP

Computer Skills Required:

  • Knowledge of Word Processing software; Spreadsheet software and Database software; practice management software and electronic medical records software.
  • Have high speed internet with good service available at your home.
    Computer Skills Preferred: Click here to enter text.

Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:

  1. The Employee is required to read, review, prepare and analyze written data and figures, using a PC or similar, and should possess visual acuity.
  2. The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.
  3. The Employee is not substantially exposed to adverse environmental conditions and; therefore, job functions are typically performed under conditions such as those found within general office or administrative work.


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