Employment Type:
Full time
Shift:
Description:
CERTIFIED RISK ADJUSTMENT CODING SPECIALIST
Location: Trinity Health PACE Corp Michigan
Status: Full time Remote
Position Purpose:
The primary purpose of your job position is to assign the appropriate diagnostic and procedural (if applicable) ICD/CPT codes to individual participant health information for data retrieval, analysis and claims processing. The certified risk adjustment coding specialist will abstract data from medical record within specified time frames and retain, validate and provide specialized education regarding documentation to support HCC's.
Position Details:
This is a fully remote position. Work hours will be 8 to 430 or 7 to 330 Eastern.
All equipment and comprehensive training will be provided.
Training will take place in person in Philadelphia, PA or Livonia, MI for two weeks (expenses paid).
What you will do:
Per standard process reviews and evaluates participant medical records to identify diagnoses and procedures and accurately assigns and sequences ICD and CPT codes. Abstracts and validates information. Seeks out validating i formation (queries physicians, clinicians) when provided information is inadequate, ambiguous or unclear for coding purposes
Responsible for documentation spot checks and audit responses. Responds/corrects audit feedback.
Assures that accurate, complete client care documentation is completed timely, in preparation for billing (RAPS, charge tickets, etc). Validates RAPS submission files.
Ensures staff are aware of and respond to alerts/queries/questions by computer, voice mail and other means. Provides feedback to clinicians and others that support completion of plans within site timelines.
Monitors and informs manager of records that are not completed timely. Monitors, investigates and takes appropriate action for records that are not coded, billed, or rejected.
Keeps abreast of coding guidelines and reimbursement reporting requirements. Brings identified concerns to manager.
Works with manager to identify, develop and implement strategies for quality improvement.
Maintains participant confidentiality and abides by HIPAA guidelines. Assures site staff compliance with federal/state and accreditation regulations through record review, case conferencing and communication.
Minimum Qualifications:
High school diploma or equivalent required.
2 years of completed college coursework preferred.
Must have one of the following certifications: Certified Outpatient Coder, Certified Coding Specialist, Certified Professional Coder thru AAPC or Registered Health Information Technologist or Registered Health Information Administrator thru AHIMA
Must be certified or obtaining certification for Certified Risk Adjustment Coder thru AAPC. If not obtaining, must obtain within one year if hired.
Two-years of experience in a risk adjustment coding environment required.
Demonstrates the ability to verify and validate HCCs.
Demonstrates the knowledge and ability to work with providers on education and guidance.
Demonstrates knowledge of medical terminology, human anatomy and physiology, and diseases processes.
Must be action-oriented, have business acumen, manage conflict well, be customer focused, have high decision quality, flexibility to adapt to ongoing change and have organizational agility.
Demonstrates superior written and verbal communication and presentation skills appropriate for audience comprehension. Able to communicate effectively with individuals and groups representing diverse perspectives.
Comprehensive to expert proficiency with Microsoft product suite (MS Word, Excel, Power Point, etc.); Ability to use other software as required to perform the essential functions of the job.
Possesses a high degree of personal accountability, responsibility and independent decision-making.
Excellent organizational skills. Ability to change and be flexible with work priorities. Strong problem-solving skills. Must exhibit critical thinking skills and possess the ability to prioritize workload.
Position may require occasional travel to home office in Livonia, MI or other supported locations.
Position Highlights and Benefits:
Comprehensive benefit packages available, including 1st Day medical coverage, dental, vision, paid time off, 403B and educational assistance.
Access to wages earned daily through Daily Pay.
Ability to earn incentives through our Employee Referral program.
Warm and supportive environment with a truly patient-centered focus.
Comprehensive Orientation and professional development opportunities
Ministry/Facility Information
Trinity Health PACE programs are nationally recognized for providing high quality, comprehensive care in the communities we serve. We are one of the largest PACE providers in the country and a part of Trinity Health, which is one of the largest not for profit, faith-based health care systems in the nation.
Trinity Health PACE programs offer continuous, quality care to the elderly, allowing them the independence of living at home. Seniors who qualify for nursing home care alternatively have the option to receive comprehensive care from an interdisciplinary team of experts, all focused on improving participants' health.
At our centers, seniors receive clinical and rehabilitation therapy and build relationships with doctors, nurses and fellow participants - all under one roof.
We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
Our core values: Reverence, Commitment to Those Who are Poor, Safety, Justice, Stewardship, Integrity
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
EOE including disability/veteran
